右美托咪定辅助全身麻醉对老年下肢骨折患者镇痛效果及术后认知功能和免疫功能的影响
|
摘要
目的评估右美托咪定辅助全身麻醉对老年下肢骨折患者镇痛效果及术后认知功能、免疫功能的影响。方法选取2017年6月至2018年6月安徽省六安市第二人民医院收治的70例全身麻醉下行下肢骨折手术老年患者作为研究对象,根据随机数字表法分为观察组和对照组,各35例。对照组采用常规全身麻醉,观察组气管插管后15 min静脉输注盐酸右美托咪定1μg/kg,再以0. 2～0.6μg/(kg·h)维持至手术结束前30 min。采用疼痛视觉模拟量表(VAS)评估镇痛效果;采用简易精神状态评价量表(MMSE)评估患者认知功能;采用流式细胞学方法检测血清CD_3~+、CD_4~+、CD_8~+含量及CD_4~+/CD_8~+比值;观察术后48 h内2组患者并发症发生情况。结果观察组患者术后1、2、4、6、8、10、12、14、16、18、20、24 h的VAS评分均低于对照组(均P <0. 01)。观察组术后1、2、7 d的MMSE评分均明显高于对照组(均P <0.05)。术后7 d时观察组术后认知功能障碍(POCD)发生率明显低于对照组[2. 9%(1/35)比17.1%(6/35)](P=0.046)。观察组术后6、24、48 h的CD_3~+、CD_4~+、CD_4~+/CD_8~+均明显高于对照组(均P <0. 05)。观察组术后48 h总并发症发生率明显低于对照组[17.1%(6/35)比57. 1%(20/35)](P=0.001)。结论右美托咪定辅助全身麻醉镇痛效果较好,可改善老年下肢骨折患者术后认知功能,降低术后免疫功能抑制,改善免疫功能,降低POCD及术后并发症发生率。
Objective To analyze the effect of general anesthesia plus dexmedetomidine on analgesia,postoperative cognitive function and immunity in elderly patients with lower limb fracture. Methods Seventy elderly patients undergoing lower limb fracture surgery from June 2017 to June 2018 in Lu'an Second People's Hospital of Anhui Province were randomly divided into observation group(n=35) and control group( n= 35). The control group had general anesthesia. The observation group had general anesthesia plus intravenous administration of dexmedetomidine hydrochloride(1 μg/kg) 15 min after endotracheal intubation, and then maintained with0. 2-0. 6 μg/(kg · h) until 30 min before the end of operation. Analgesia effect was analyzed by Visual Analogue Scale(VAS). Cognitive function was assessed by Mini-Mental State Scale(MMSE). Serum levels of CD_3~+, CD_4~+,CD8~+ and CD_4~+/CD_8~+ were tested by flow cytometry. Postoperative 48 h complications were observed. Results VAS pain scores at 1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 24 h after operation in the observation group were significantly lower than those in the control group(P<0.01). MMSE scores at 1, 2, 7 d after operation in the observation group were significantly higher than those in the control group(P < 0.05). Incidence of postoperative cognitive dysfunction( POCD) in 7 d in the observation group was significantly lower than that in the control group[2. 9%(1/35) vs 17. 1 %(6/35) ](P = 0. 046). Levels of CD_3~+,CD_4~+ and CD_4~+/CD8~+ at 6,24,48 h after operation in the observation group were significantly higher than those in the control group(P < 0. 05). Total incidence of complications in the observation group was significantly lower than that in the control group [ 17. 1%(6/35) vs 57. 1 %(20/35) ](P = 0. 001). Conclusion General anesthesia assisted with dexmedetomidine can enhance the analgesia effect and alleviate cognitive impairment, improve immune function, reduce POCD and postoperative complications in elderly patients undergoing lower limb fracture surgery.
Objective To analyze the effect of general anesthesia plus dexmedetomidine on analgesia,postoperative cognitive function and immunity in elderly patients with lower limb fracture. Methods Seventy elderly patients undergoing lower limb fracture surgery from June 2017 to June 2018 in Lu'an Second People's Hospital of Anhui Province were randomly divided into observation group(n=35) and control group( n= 35). The control group had general anesthesia. The observation group had general anesthesia plus intravenous administration of dexmedetomidine hydrochloride(1 μg/kg) 15 min after endotracheal intubation, and then maintained with0. 2-0. 6 μg/(kg · h) until 30 min before the end of operation. Analgesia effect was analyzed by Visual Analogue Scale(VAS). Cognitive function was assessed by Mini-Mental State Scale(MMSE). Serum levels of CD_3~+, CD_4~+,CD8~+ and CD_4~+/CD_8~+ were tested by flow cytometry. Postoperative 48 h complications were observed. Results VAS pain scores at 1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 24 h after operation in the observation group were significantly lower than those in the control group(P<0.01). MMSE scores at 1, 2, 7 d after operation in the observation group were significantly higher than those in the control group(P < 0.05). Incidence of postoperative cognitive dysfunction( POCD) in 7 d in the observation group was significantly lower than that in the control group[2. 9%(1/35) vs 17. 1 %(6/35) ](P = 0. 046). Levels of CD_3~+,CD_4~+ and CD_4~+/CD8~+ at 6,24,48 h after operation in the observation group were significantly higher than those in the control group(P < 0. 05). Total incidence of complications in the observation group was significantly lower than that in the control group [ 17. 1%(6/35) vs 57. 1 %(20/35) ](P = 0. 001). Conclusion General anesthesia assisted with dexmedetomidine can enhance the analgesia effect and alleviate cognitive impairment, improve immune function, reduce POCD and postoperative complications in elderly patients undergoing lower limb fracture surgery.
引文
[1] Chen W, Liu B, Zhang F, et al. The effects of dexmedetomidine on post-operative cognitive dysfunction and inflammatory factors in senile patients[J]. Int J Clin Exp Med, 2014,8(3):4601-4605.
[2]张曙报,梅玫,吕文艳,等.右美托咪定对老年脊柱手术患者应激反应和术后早期认知功能的影响[J].中华全科医学,2017,15(2):249-251,273. DOI:10. 16766/j. cnki. issn. 1674-4152.2017.02.020.Zhang SB, Mei M, Lyu WY, et al. Influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation[J]. Chinese Journal of General Practice,2017,15(2):249-251,273. DOI:10. 16766/j. cnki. issn. 1674-4152.2017.02.020.
[3] Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery[J]. Anesth Analg, 2018,127(2):496-505.DOI:10. 1213/ANE. 0000000000003514.
[4]郑熠.右美托咪定对老年患者全身麻醉术后认知功能障碍的影响[J].中国医药,2018,13(6):934-937.DOI:10.3760/j.issn. 1673-4777.2018.06.034.Zheng Y. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia[J].China Medicine, 2018,13(6):934-937. DOI:10. 3760/j. issn.1673-4777.2018.06.034.
[5]张洪侠,周桂桐.老年人跌倒与平衡功能异常[J].中国老年学杂志,2015,35(5):1434-1435. DOI:10. 3969/j. issn. 1005-9202.2015.05.137.Zhang HX, Zhou GT. Fall and balance dysfunction in the elderly[J].Chinese Journal of Gerontology, 2015,35(5):1434-1435. DOI:10.3969/j. issn. 1005-9202. 2015.05.137.
[6]王浩,赵鸣,段蕾蕾,等.社区60岁及以上老年人跌倒现状及相关因素分析[J].伤害医学:电子版,2016,5(3):16-21.DOI:10.3868/j. issn.2095-1566.2016.03.004.Wang H, Zhao M, Duan LL,et al. Analysis of fall incidence and related factors in community-dwelling elders[J]. Injury Medicine(Electronic Edition), 2016,5(3):16-21. DOI:10.3868/j. issn.2095-1566.2016.03.004.
[7]李茜,张庆军,张岚.2016年湖北省伤害监测点老年跌倒/坠落病例特征分析[J].伤害医学:电子版,2017,6(3):41-46. DOI:10.3868/j. issn.2095-1566.2017.03.009.Li Q, Zhang QJ, Zhang L. Epidemic characteristics of fall-related injuries in elderly people reported in Hubei Injury Surveillance System during 2016[J]. Injury Medicine(Electronic Edition),2017,6(3):4146. DOI:10. 3868/j. issn. 2095-1566. 2017.03.009.
[8] Ren KW, Shen N, Tang JL, et al. Effects of ulinastatin on inflammatory response and cognitive function after hip arthroplasty for the elderly patients with femoral neck fracture[J]. Eur Rev Med Pharmacol Sci, 2018,22(4):1126-1132. DOI:10. 26355/eurrev_201802_14401.
[9] Zhang J, Wang G, Zhang F, et al. Improvement of postoperative cognitive dysfunction and attention network function of patients with ischemic cerebrovascular disease via dexmedetomidine[J]. Exp Ther Med, 2018,15(3):2968-2972. DOI:10.3892/etm.2018.5806.
[10]解康杰,方军,连燕虹,等.右美托咪定改善术后认知功能障碍的机制及进展[J].国际麻醉学与复苏杂志,2017,38(10):925-929. DOI:10.3760/cma.j.issn. 1673-4378.2017.10.014.Xie KJ, Fang J, Lian YH, et al. Dexmedetomidine improves postoperative cognitive dysfunction:mechanism and progress[J].International Journal of Anesthesiology and Resuscitation, 2017,38(10):925-929. DOI:10. 3760/cma. j. issn. 1673-4378. 2017.10.014.
[11]李明峡,胡宪文,张琪,等.右美托咪定复合舒芬太尼在下肢骨折患者术后静脉自控镇痛中的应用[J].安徽医科大学学报,2015,50(6):850-854.Li MX, Hu XW, Zhang Q, et al. Effect of sufentanil combined with dexmedetomidine on postoperative patient-controlled intravenous analgesia in patients undergoing lower limb fracture surgery[J]. Acta Universitatis Medicinalis Anhui, 2015,50(6):850-854.
[12]杜宁,王颖,杨海昌,等.右美托咪定对老年骨科全麻患者术后谵妄的影响[J].中国煤炭工业医学杂志,2016,19(9):1316-1318. DOI:10.11723/mtgyyx1007-9564201609018.Du N, Wang Y, Yang HC, et al. Effect of dexmetomidine on postoperative delirium in elderly patients with orthopaedic general anesthesia[J]. Chinese Journal of Coal Industry Medicine, 2016,19(9):1316-1318. DOI:10.11723/mtgyyx1007-9564201609018.
[13] Kim SY, Chang CH, Lee JS, et al. Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis:a prospective, randomized study[J]. JVIR, 2013,24(6):779-786. DOI:10. 1016/j.jvir.2013.02.034.
[14]Zhao JN,Kong M,Qi B,et al. Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients:a prospective, randomized,controlled clinical trial[J]. Medicine(Baltimore), 2016,95(33):e4576. DOI:10. 1097/MD. 0000000000004576.
[15]冉德伟.右美托咪定超前镇痛在腰椎间盘突出症手术中的应用价值[J].中国医药,2017,12(12):1888-1891. DOI:10.3760/cma. j. issn. 1673-4777.2017.12.034.Ran DW. Value of dexmedetomidine preemptive analgesia in lumbar disc herniation operation[J]. China Medicine, 2017,12(12):1888-1891. DOI:10. 3760/cma. j. issn. 1673-4777.2017.12.034.
[2]张曙报,梅玫,吕文艳,等.右美托咪定对老年脊柱手术患者应激反应和术后早期认知功能的影响[J].中华全科医学,2017,15(2):249-251,273. DOI:10. 16766/j. cnki. issn. 1674-4152.2017.02.020.Zhang SB, Mei M, Lyu WY, et al. Influence of dexmedetomidine on stress response and early cognitive function of elderly patients after spinal operation[J]. Chinese Journal of General Practice,2017,15(2):249-251,273. DOI:10. 16766/j. cnki. issn. 1674-4152.2017.02.020.
[3] Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery[J]. Anesth Analg, 2018,127(2):496-505.DOI:10. 1213/ANE. 0000000000003514.
[4]郑熠.右美托咪定对老年患者全身麻醉术后认知功能障碍的影响[J].中国医药,2018,13(6):934-937.DOI:10.3760/j.issn. 1673-4777.2018.06.034.Zheng Y. Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients undergoing general anesthesia[J].China Medicine, 2018,13(6):934-937. DOI:10. 3760/j. issn.1673-4777.2018.06.034.
[5]张洪侠,周桂桐.老年人跌倒与平衡功能异常[J].中国老年学杂志,2015,35(5):1434-1435. DOI:10. 3969/j. issn. 1005-9202.2015.05.137.Zhang HX, Zhou GT. Fall and balance dysfunction in the elderly[J].Chinese Journal of Gerontology, 2015,35(5):1434-1435. DOI:10.3969/j. issn. 1005-9202. 2015.05.137.
[6]王浩,赵鸣,段蕾蕾,等.社区60岁及以上老年人跌倒现状及相关因素分析[J].伤害医学:电子版,2016,5(3):16-21.DOI:10.3868/j. issn.2095-1566.2016.03.004.Wang H, Zhao M, Duan LL,et al. Analysis of fall incidence and related factors in community-dwelling elders[J]. Injury Medicine(Electronic Edition), 2016,5(3):16-21. DOI:10.3868/j. issn.2095-1566.2016.03.004.
[7]李茜,张庆军,张岚.2016年湖北省伤害监测点老年跌倒/坠落病例特征分析[J].伤害医学:电子版,2017,6(3):41-46. DOI:10.3868/j. issn.2095-1566.2017.03.009.Li Q, Zhang QJ, Zhang L. Epidemic characteristics of fall-related injuries in elderly people reported in Hubei Injury Surveillance System during 2016[J]. Injury Medicine(Electronic Edition),2017,6(3):4146. DOI:10. 3868/j. issn. 2095-1566. 2017.03.009.
[8] Ren KW, Shen N, Tang JL, et al. Effects of ulinastatin on inflammatory response and cognitive function after hip arthroplasty for the elderly patients with femoral neck fracture[J]. Eur Rev Med Pharmacol Sci, 2018,22(4):1126-1132. DOI:10. 26355/eurrev_201802_14401.
[9] Zhang J, Wang G, Zhang F, et al. Improvement of postoperative cognitive dysfunction and attention network function of patients with ischemic cerebrovascular disease via dexmedetomidine[J]. Exp Ther Med, 2018,15(3):2968-2972. DOI:10.3892/etm.2018.5806.
[10]解康杰,方军,连燕虹,等.右美托咪定改善术后认知功能障碍的机制及进展[J].国际麻醉学与复苏杂志,2017,38(10):925-929. DOI:10.3760/cma.j.issn. 1673-4378.2017.10.014.Xie KJ, Fang J, Lian YH, et al. Dexmedetomidine improves postoperative cognitive dysfunction:mechanism and progress[J].International Journal of Anesthesiology and Resuscitation, 2017,38(10):925-929. DOI:10. 3760/cma. j. issn. 1673-4378. 2017.10.014.
[11]李明峡,胡宪文,张琪,等.右美托咪定复合舒芬太尼在下肢骨折患者术后静脉自控镇痛中的应用[J].安徽医科大学学报,2015,50(6):850-854.Li MX, Hu XW, Zhang Q, et al. Effect of sufentanil combined with dexmedetomidine on postoperative patient-controlled intravenous analgesia in patients undergoing lower limb fracture surgery[J]. Acta Universitatis Medicinalis Anhui, 2015,50(6):850-854.
[12]杜宁,王颖,杨海昌,等.右美托咪定对老年骨科全麻患者术后谵妄的影响[J].中国煤炭工业医学杂志,2016,19(9):1316-1318. DOI:10.11723/mtgyyx1007-9564201609018.Du N, Wang Y, Yang HC, et al. Effect of dexmetomidine on postoperative delirium in elderly patients with orthopaedic general anesthesia[J]. Chinese Journal of Coal Industry Medicine, 2016,19(9):1316-1318. DOI:10.11723/mtgyyx1007-9564201609018.
[13] Kim SY, Chang CH, Lee JS, et al. Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis:a prospective, randomized study[J]. JVIR, 2013,24(6):779-786. DOI:10. 1016/j.jvir.2013.02.034.
[14]Zhao JN,Kong M,Qi B,et al. Comparison of the morphine-sparing effect of intraoperative dexmedetomidine with and without loading dose following general anesthesia in multiple-fracture patients:a prospective, randomized,controlled clinical trial[J]. Medicine(Baltimore), 2016,95(33):e4576. DOI:10. 1097/MD. 0000000000004576.
[15]冉德伟.右美托咪定超前镇痛在腰椎间盘突出症手术中的应用价值[J].中国医药,2017,12(12):1888-1891. DOI:10.3760/cma. j. issn. 1673-4777.2017.12.034.Ran DW. Value of dexmedetomidine preemptive analgesia in lumbar disc herniation operation[J]. China Medicine, 2017,12(12):1888-1891. DOI:10. 3760/cma. j. issn. 1673-4777.2017.12.034.