摘要
目的 探讨右美托咪定对腰椎手术自体血回输患者炎症应激反应的影响.方法 前瞻性选取2021年1月至2022年12月在沧州市中心医院行腰椎手术自体血回输患者120例作为研究对象,按照信封法将患者分为观察组(n=60)和对照组(n=60).观察组给予右美托咪定持续泵注,对照组给予等量0.9％氯化钠溶液泵注.观察两组术中指标(手术时间、术中出血量),麻醉前30 min(T0)、自体血回输6h(T1)、自体血回输12 h(T2)和自体血回输24 h(T3)时白细胞介素(IL)-1β、IL-6、肿瘤坏死因素-α(TNF-α)、皮质醇、去甲肾上腺素(NE)、肾上腺素(E)的差异,手术前后易智力状态检查量表(MMSE)变化和术后认知功能障碍(POCD)发生情况.结果 两组的手术时间、术中出血量、回输血量和补液量比较,差异均无统计学意义(P＞0.05)e T1、T2和T3时,两组IL-1β、IL-6和TNF-α水平均较T0升高,差异均有统计学意义(P＜0.05);观察组T1、T2和T3时IL-1β、IL-6和TNF-α水平均明显低于对照组,差异均有统计学意义(P＜0.05).T1、T2时,两组皮质醇水平均较T0升高,T3时,两组皮质醇较T0降低,T1、T2、T3时,两组NE和E水平均较T0升高,差异均有统计学意义(P＜0.05);观察组T1、T2和T3时皮质醇、NE和E水平均明显低于对照组,差异均有统计学意义(P＜0.05).术后1 d时,两组MMSE评分均较术前降低,且观察组术后1 d时MMSE评分为(26.06±1.00)分,高于对照组[(24.82±0.98)分],差异均有统计学意义(P＜0.05).观察组POCD发生率为3.33％,低于对照组(20.00％),差异有统计学意义(P＜0.05).结论 右美托咪定有助于缓解腰椎手术自体血回输患者炎症应激反应,对患者认知功能有一定保护作用.
Abstract
Objective To explore the effect of dexmedetomidine on inflammatory stress response in patients undergoing lumbar spine sur-gery with autologous blood transfusion.Methods A total of 120 patients undergoing autologous blood transfusion for lumbar spine surgery in Cang-zhou Central Hospital from January 2021 to December 2022 were prospectively selected as the study subjects.The patients were divided into the observation group(n=60)and the control group(n=60)according to the envelope method.The observation group was given continuous pum-ping of dexmedetomidine,and the control group was given pumping of the same amount of 0.9％sodium chloride solution.The intraoperative inde-xes(operation time,intraoperative blood loss),the differences of interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),cortisol,norepinephrine(NE)and epinephrine(E)at 30 minutes before anesthesia(T0),6 hours after autologous blood transfusion(T1),12 hours after autologous blood transfusion(T2),and 24 hours after autologous blood transfusion(T3),the changes of mini-mental state examination(MMSE)before and after operation and the occurrence of postoperative cognitive dysfunction(POCD)were observed.Results There were no statistically significant differences in operation time,intraoperative blood loss,blood transfusion and fluid infusion between the two groups(P＞0.05).At T1,T2 and T3,the levels of IL-1 β,IL-6 and TNF-α in the two groups were higher than those at T0,and the differences were sta-tistically significant(P＜0.05).The levels of IL-1 β,IL-6 and TNF-α at T1,T2 and T3 in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P＜0.05).At T1 and T2,the levels of cortisol in the two groups were higher than those at T0,the levels of cortisol in the two groups at T3 were lower than those at T0,at T1,T2 and T3,the levels of NE and E in the two groups were higher than those at T0,and the differences were statistically significant(P＜0.05).The levels of cortisol,NE and E at T1,T2 and T3 in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P＜0.05).At 1d after operation,the MMSE scores of the two groups were lower than those before operation,and the MMSE score of the obser-vation group was(26.06±1.00)points at 1 d after operation,which was higher than that of the control group[(24.82±0.98)points],the differences were statistically significant(P＜0.05).The incidence of POCD in the observation group was 3.33％,which was lower than that in the control group(20.00％),and the difference was statistically significant(P＜0.05).Conclusion Dexmedetomidine can help alleviate the inflammatory stress response in patients undergoing lumbar spine surgery with autologous blood transfusion,and has a certain protective effect on their cognitive function.
维普
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