摘要
目的 研究不同剂量右美托咪定对腰椎手术自体血回输患者炎症反应、氧化应激反应的影响.方法 前瞻性选取2021年1月至2022年12月在沧州市中心医院接受腰椎手术,并进行自体血回输的120例患者为研究对象,按照简单随机法将其分为对照组和观察组,每组各60例.对照组给予0.5 μg/kg负荷剂量的右美托咪定持续输注15 min,后以0.5 μg/kg维持,观察组给予1.0 µg/kg负荷剂量的右美托咪定持续输注15 min,后以1.0 μg/kg维持.比较麻醉诱导前(T0)、自体输血前(T1)、自体输血后1 h(T2)、自体输血后6 h(T3)、自体输血后12 h(T4)两组患者炎症因子[白细胞介素(IL)-1β、IL-6、IL-8、肿瘤坏死因子-α(TNF-α)]、氧化应激反应因子[丙二醛、超氧化物歧化酶(SOD)]的差异,记录两组患者自控静脉镇痛(PCIA)按压次数、补救镇痛次数及术后48 h视觉模拟评分法(VAS)评分,统计两组术后5 d内发生率及术后认知功能障碍(POCD).结果 T1、T2、T3、T4时,两组IL-1β、IL-6、IL-8、TNF-α水平均较T0时升高,差异均有统计学意义(P＜0.05);观察组T1、T2、T3、T4时的IL-1β、IL-6、IL-8、TNF-α水平均低于对照组,差异均有统计学意义(P＜0.05).T1、T2、T3、T4时,两组丙二醛均较T0时升高,SOD均较T0时降低,观察组T1、T2、T3、T4时的丙二醛低于对照组,SOD高于对照组,差异均有统计学意义(P＜0.05);观察组T1、T2、T3、T4时丙二醛低于对照组,SOD高于对照组,差异均有统计学意义(P＜0.05).观察组术后48 h内PCIA按压次数、补救镇痛次数及术后 48 h VAS 评分分别为(19.05±3.74)次、(1.87±0.21)分、(1.71±0.20)次,均低于对照组[(21.12±4.28)次、(2.12±0.25)分、(1.93±0.21)次],术后5 d的POCD发生率为3.33％,低于对照组(15.00％),差异均有统计学意义(P＜0.05).观察组窦性心动过缓、低血压、低氧血症等累计并发症发生率与对照组比较,差异无统计学意义(P＞0.05).结论 1.0 µg/kg负荷剂量的右美托咪定可抑制腰椎手术自体血回输患者体内炎症因子的释放,减轻机体氧化应激反应,有利于降低POCD的发生率,且不增加不良反应.
Abstract
Objective To study the effect of different doses of dexmedetomidine on inflammatory reaction and oxidative stress in patients undergoing autologous blood transfusion for lumbar spine surgery.Methods A total of 120 patients undergoing lumbar spine surgery and autolo-gous blood transfusion in Cangzhou Central Hospital from January 2021 to December 2022 were prospectively selected as the research objects.They were divided into the control group and the observation group according to simple random method,60 cases in each group.The control group re-ceived a loading dose of 0.5 μg/kg dexmedetomidine administered over 15 minutes followed by maintenance of 0.5 μg/kg.The observation group received a loading dose of 1.0 μg/kg dexmedeto-midine administered over 15 minutes followed by maintenance of 1.0 μg/kg.The levels of in-flammatory factors[interleukin(IL)-1β,IL-6,IL-8,tumor necrosis factor-α(TNF-α)]and oxidative stress factors[maleic dialdehyde,superoxide dismutase(SOD)]were compared before induction of anesthesia(T0),before autologous transfusion(T,),1 hour after autologous transfusion(T2),6 hours after autologous transfusion(T3),and 12 hours after autologous transfusion(T4).The number of patient controlled in-travenous analgesia(PCI A)presses,remedial analgesia with in 48 h after operation and the visual analog scale(VAS)scores on the 48 h after op-eration were recorded.The postoperative cognitive dysfunction(POCD)with 5 d after operation of the two groups were recorded,and complica-tions were also recorded and compared between the groups.Results At T1,T2,T3 and T4,the levels of IL-1 β,IL-6,IL-8 and TNF-αin the two groups were higher than those at T0,and the levels of IL-1 β,IL-6,IL-8 and TNF-α at T1,T2,T3 and T4 in the observation group were lower than those in the control group,and the differences were statistically significant(P＜0.05).At T1,T2,T3 and T4,the maleic dialdehyde of the two groups was higher than that at T0,and the SOD was lower than that at T0,and the maleic dialdehyde of the observation group at T1,T2,T3 and T4 was lower than that of the control group,and the SOD at T1,T2,T3 and T4 was higher than that of the control group,the differences were statistically significant(P＜0.05).The PCI A pressing times,remedial analgesia times within 48 h after operation and VAS score on the 48 h after operation in the observation group were(19.05±3.74)times,(1.71±0.20)times and(1.87±0.21)points,respec-tively,which were lower than those in the control group[(21.12±4.28)times,(1.93±0.21)times and(2.12±0.25)points],the inci-dence of POCD at 5 d after operation was 3.33％,which was lower than that in the control group(15.00％),and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the cumulative incidence of complications such as bradycardia,hypo-tension and hypoxemia between the two groups(P＞0.05).Conclusion The 1.0 μg/kg loading dose of dexmedetomidine can inhibit the re-lease of inflammatory factors in patients with autologous blood transfusion for lumbar spine surgery,reduce the body's oxidative stress,and help to reduce the incidence of postoperative POCD without increasing adverse effects.
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