右美托咪定辅助全身麻醉对老年股骨颈骨折患者血清T淋巴细胞亚群水平的影响
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摘要
目的探讨右美托咪定辅助全身麻醉对老年股骨颈骨折患者血清T淋巴细胞亚群水平的影响。方法选取2017年2月～2019年1月宁波大学医学院附属医院86例股骨颈骨折老年患者,择期行全身麻醉下髋关节置换术,依据麻醉方案不同将其分为观察组和对照组,每组各43例。观察组于麻醉诱导前予以0.5μg/kg右美托咪定,经静脉输液泵注射;对照组于麻醉诱导前予以等容量生理盐水,经静脉输液泵注射。两组分别于给药前(T_0)、给药10 min(T_1)、气管插管即刻(T_2)、手术切皮(T_3)、手术进行30 min(T_4)、术毕(T_5)、气管插管拔除后5 min(T_6)、气管插管拔除后30 min(T_7)监测患者心率(HR)、平均动脉压(MAP);采用流式细胞仪检测术前和术后1、3 d外周血中CD3~+、CD4~+、CD8~+、CD4~+/CD8~+;采用简易精神状态量表(MMSE)评估术前和术后1、3、7 d认知功能,并统计术中丙泊酚、芬太尼用量及不良反应发生率。结果观察组T_2、T_6时间点的HR、MAP均低于对照组(P <0.05);观察组术中芬太尼、丙泊酚用量少于对照组(P <0.05);观察组术后1、3 d外周血中CD3~+、CD4~+、CD4~+/CD8~+水平高于对照组,CD8~+水平低于对照组(P <0.05);观察组术后1、3、7 d的认知功能评分高于对照组(P <0.05);两组不良反应发生率比较,差异无统计学意义(P> 0.05)。结论右美托咪定辅助全身麻醉应用于老年股骨颈骨折患者,有助于减少其术中麻醉药物用量,维持围术期血流动力学稳定,且对患者T淋巴亚群细胞及认知功能影响较小,安全性高。
Objective To explore the effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture. Methods From February 2017 to January 2019, 86 elderly patients with femoral neck fracture from the Affiliated Hospital of Medical School of Ningbo University were selected to undergo hip replacement under general anesthesia. They were divided into observation group and control group according to different anesthesia schemes, with 43 cases in each group. The observation group was given 0.5 μg/kg Dexmedetomidine before induction of anesthesia and injected by intravenous infusion pump. The control group was given normal saline of equal volume before induction of anesthesia and injected by intravenous infusion pump. Heart rate(HR) and mean arterial pressure(MAP) were monitored before administration(T_0), 10 minutes after administration(T_1),immediately after tracheal intubation(T_2), skin incision(T_3), 30 minutes after operation(T_4), 5 minutes after tracheal intubation(T_6), 30 minutes after tracheal intubation(T_7). Flow cytometry was used to detect the levels of CD3~+, CD4~+,CD8~+, CD4~+/CD8~+in peripheral blood before and 1 d after surgery. Cognitive function was assessed before and after 1,3, 7 days by mini-mental state examination(MMSE), and the amount of Propofol and Fentanyl during operation and the incidence of adverse reactions were counted. Results The HR and MAP of T_2 and T_6 in the observation group were lower than those in the control group(P < 0.05); Fentanyl and Propofol used in the observation group were less than those in the control group(P < 0.05); CD3~+, CD4~+, CD4~+/CD8~+of peripheral blood in the observation group were higher than those in the control group at 1 and 3 days after operation, and CD8~+level was lower than that in the control group(P <0.05). Cognitive function score in the observation group were higher than that in the control group at 1, 3 and 7 days after operation(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion The application of Dexmedetomidine-assisted general anesthesia in elderly patients with femoral neck fracture is helpful to reduce the amount of anesthetics used during the operation and maintain the stability of perioperative hemodynamics. It has little effect on T lymphocyte subsets and cognitive function,with high safety.
Objective To explore the effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture. Methods From February 2017 to January 2019, 86 elderly patients with femoral neck fracture from the Affiliated Hospital of Medical School of Ningbo University were selected to undergo hip replacement under general anesthesia. They were divided into observation group and control group according to different anesthesia schemes, with 43 cases in each group. The observation group was given 0.5 μg/kg Dexmedetomidine before induction of anesthesia and injected by intravenous infusion pump. The control group was given normal saline of equal volume before induction of anesthesia and injected by intravenous infusion pump. Heart rate(HR) and mean arterial pressure(MAP) were monitored before administration(T_0), 10 minutes after administration(T_1),immediately after tracheal intubation(T_2), skin incision(T_3), 30 minutes after operation(T_4), 5 minutes after tracheal intubation(T_6), 30 minutes after tracheal intubation(T_7). Flow cytometry was used to detect the levels of CD3~+, CD4~+,CD8~+, CD4~+/CD8~+in peripheral blood before and 1 d after surgery. Cognitive function was assessed before and after 1,3, 7 days by mini-mental state examination(MMSE), and the amount of Propofol and Fentanyl during operation and the incidence of adverse reactions were counted. Results The HR and MAP of T_2 and T_6 in the observation group were lower than those in the control group(P < 0.05); Fentanyl and Propofol used in the observation group were less than those in the control group(P < 0.05); CD3~+, CD4~+, CD4~+/CD8~+of peripheral blood in the observation group were higher than those in the control group at 1 and 3 days after operation, and CD8~+level was lower than that in the control group(P <0.05). Cognitive function score in the observation group were higher than that in the control group at 1, 3 and 7 days after operation(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05). Conclusion The application of Dexmedetomidine-assisted general anesthesia in elderly patients with femoral neck fracture is helpful to reduce the amount of anesthetics used during the operation and maintain the stability of perioperative hemodynamics. It has little effect on T lymphocyte subsets and cognitive function,with high safety.
引文
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[6]冯钲华.全身麻醉与硬膜外麻醉对老年髋关节置换术后患者认知功能的影响[J].临床医学,2017,37(4):83-85.
[7]郭晓丽,蒋敏,李海波,等.不同麻醉方法对老年患者髋关节置换术术后认知功能障碍的影响[J].现代生物医学进展,2016,16(26):5106-5108.
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[9]倪丽亚,孙超智,李斌本,等.髂筋膜间隙阻滞复合喉罩全麻在高龄髋关节置换术患者中的应用[J].第二军医大学学报,2017,38(4):452-457.
[10]张金圈,刘森,卜少卿,等.中药联合亚麻醉剂量氨氯铜调理对高龄股骨颈骨折患者术后认知功能障碍的影响[J].河北医药,2018,40(18):33-37.
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[12]李建辉,郝丽娜,侯少科,等.不同麻醉方式对老年患者髋关节置换术后短期认知功能的影响[J].中国老年学杂志,2017,37(6):1459-1461.
[13] Cho JS,Kim SH,Shin S,et al. Effects of dexmedetomidineon changes in heart rate variability and hemodynamics during tracheal intubation[J]. Am J Ther,2016,23(2):369-376.
[14]黄玉玲,吴涯雯,陈友权,等.右美托咪定对全身麻醉气管插管期心血管反应的影响[J].重庆医学,2015,44(19):2664-2665.
[15]绪磊,郝建华.不同剂量右美托咪定对高血压患者腹部手术血流动力学的影响[J].新乡医学院学报,2015,32(4):340-343.
[16]梁是,徐斌,李学斌,等.盐酸右美托咪定在膝关节镜手术腰硬联合麻醉中的应用效果及安全性[J].中国医院用药评价与分析,2017,17(7):897-899.
[17]刘洋,高东艳.右美托咪定在老年骨科患者麻醉中的应用进展[J].中国现代医生,2018,56(15):164-168.
[18]陈波,祝家群,屠文龙,等.右美托咪定对腹腔镜手术患者围手术期血液动力学、镇痛效果及安全性研究[J].中国现代医生,2017,55(36):119-123,127.
[19]杨红星,贾国丛,王阳.右美托咪定对乳腺癌根治术患者的麻醉效果及T淋巴细胞亚群的影响分析[J].癌症进展,2018,16(4):103-106.
[20]王小锐,李阳阳,万亮,等.右美托咪定辅助麻醉对老年阿尔茨海默病髋关节置换术患者炎症因子及T淋巴细胞亚群的影响[J].海南医学院学报,2017,23(7):925-931.
[21]安杰,李海军,张嘉智.浅析老年下肢骨创伤手术后认知功能障碍与不同的麻醉与镇痛方法的关联性[J].内蒙古医学杂志,2017,49(3):346-348.
[22]张高峰,杨佩,王强,等.围术期连续股神经阻滞对老年股骨颈骨折病人术后认知功能障碍的影响[J].中华麻醉学杂志,2018,38(1):66.
[23]胡计嬅,嵇富海,杨建平,等.不同剂量右美托咪定对麻醉维持自主呼吸恢复时间、定向力恢复时间及不良反应发生率的影响[J].临床和实验医学杂志,2017,16(24):2484-2487.
[24]马臻杰,李钊伟.右美托咪定复合丙泊酚全凭静脉麻醉对老年骨科手术患者术后康复期的影响[J].中国老年学杂志,2015,35(7):1831-1832.
[25] Fujimoto D,Egi M,Obata N,et al. Vital Sign Changes and the Requirement of Analgesics after Discontinuation of Dexmedetomidine in Patients after Esophageal Cancer Surgery[J]. Masui,2016,65(8):795-800.
[26]宋文英,郑伟,宋宇龙,等.右美托咪定对脑缺血再灌注损伤大鼠认知功能及神经功能的保护作用研究[J].临床和实验医学杂志,2019,18(1):18-21.
[2]张海霞.腰-硬联合麻醉和全身麻醉在老年患者股骨颈骨折手术中的麻醉效果[J].吉林医学,2015,36(14):3019-3020.
[3]刘文海,杨保仲.腰硬联合麻醉复合全身麻醉在老年股骨颈骨折患者手术的麻醉效果分析[J].中外医学研究,2015,13(19):110-111.
[4]廖榕东,郑勤,廖燕,等.腰硬联合麻醉和全身麻醉在老年股骨颈骨折手术中的应用效果[J].中国实用医刊,2016,43(1):24-25.
[5]康雅琴,朱红.两种麻醉对老年患者髋关节置换术后认知功能影响的观察[J].当代医学,2015,21(12):68-69.
[6]冯钲华.全身麻醉与硬膜外麻醉对老年髋关节置换术后患者认知功能的影响[J].临床医学,2017,37(4):83-85.
[7]郭晓丽,蒋敏,李海波,等.不同麻醉方法对老年患者髋关节置换术术后认知功能障碍的影响[J].现代生物医学进展,2016,16(26):5106-5108.
[8] Ozer A,Comu FM,Kucuk A,et al. Effects of dexmedetomidine and thymoquinone on erythrocyte deformability in lower limb ischemia reperfusion injury in streptozotocininduced diabetic rats[J]. Bratisl Lek Listy,2018,119(10):642-645.
[9]倪丽亚,孙超智,李斌本,等.髂筋膜间隙阻滞复合喉罩全麻在高龄髋关节置换术患者中的应用[J].第二军医大学学报,2017,38(4):452-457.
[10]张金圈,刘森,卜少卿,等.中药联合亚麻醉剂量氨氯铜调理对高龄股骨颈骨折患者术后认知功能障碍的影响[J].河北医药,2018,40(18):33-37.
[11]高书军.不同麻醉方式对老年髋关节置换术后患者认知功能的影响[J].贵阳医学院学报,2015,40(1):100-103.
[12]李建辉,郝丽娜,侯少科,等.不同麻醉方式对老年患者髋关节置换术后短期认知功能的影响[J].中国老年学杂志,2017,37(6):1459-1461.
[13] Cho JS,Kim SH,Shin S,et al. Effects of dexmedetomidineon changes in heart rate variability and hemodynamics during tracheal intubation[J]. Am J Ther,2016,23(2):369-376.
[14]黄玉玲,吴涯雯,陈友权,等.右美托咪定对全身麻醉气管插管期心血管反应的影响[J].重庆医学,2015,44(19):2664-2665.
[15]绪磊,郝建华.不同剂量右美托咪定对高血压患者腹部手术血流动力学的影响[J].新乡医学院学报,2015,32(4):340-343.
[16]梁是,徐斌,李学斌,等.盐酸右美托咪定在膝关节镜手术腰硬联合麻醉中的应用效果及安全性[J].中国医院用药评价与分析,2017,17(7):897-899.
[17]刘洋,高东艳.右美托咪定在老年骨科患者麻醉中的应用进展[J].中国现代医生,2018,56(15):164-168.
[18]陈波,祝家群,屠文龙,等.右美托咪定对腹腔镜手术患者围手术期血液动力学、镇痛效果及安全性研究[J].中国现代医生,2017,55(36):119-123,127.
[19]杨红星,贾国丛,王阳.右美托咪定对乳腺癌根治术患者的麻醉效果及T淋巴细胞亚群的影响分析[J].癌症进展,2018,16(4):103-106.
[20]王小锐,李阳阳,万亮,等.右美托咪定辅助麻醉对老年阿尔茨海默病髋关节置换术患者炎症因子及T淋巴细胞亚群的影响[J].海南医学院学报,2017,23(7):925-931.
[21]安杰,李海军,张嘉智.浅析老年下肢骨创伤手术后认知功能障碍与不同的麻醉与镇痛方法的关联性[J].内蒙古医学杂志,2017,49(3):346-348.
[22]张高峰,杨佩,王强,等.围术期连续股神经阻滞对老年股骨颈骨折病人术后认知功能障碍的影响[J].中华麻醉学杂志,2018,38(1):66.
[23]胡计嬅,嵇富海,杨建平,等.不同剂量右美托咪定对麻醉维持自主呼吸恢复时间、定向力恢复时间及不良反应发生率的影响[J].临床和实验医学杂志,2017,16(24):2484-2487.
[24]马臻杰,李钊伟.右美托咪定复合丙泊酚全凭静脉麻醉对老年骨科手术患者术后康复期的影响[J].中国老年学杂志,2015,35(7):1831-1832.
[25] Fujimoto D,Egi M,Obata N,et al. Vital Sign Changes and the Requirement of Analgesics after Discontinuation of Dexmedetomidine in Patients after Esophageal Cancer Surgery[J]. Masui,2016,65(8):795-800.
[26]宋文英,郑伟,宋宇龙,等.右美托咪定对脑缺血再灌注损伤大鼠认知功能及神经功能的保护作用研究[J].临床和实验医学杂志,2019,18(1):18-21.