摘要
目的 探讨右美托咪定对行膝关节置换术老年患者神经、认知功能及炎性因子表达的影响.方法 选取2022 年3 月至 2023 年 3 月择期行人工单侧全膝关节置换术的老年患者 120 例,按随机数字表法分为A、B、C、D组,每组30 例.A组予以腰硬联合麻醉,B、C、D组在腰硬联合麻醉基础上于麻醉平面固定后先给予0.50 μg/kg负荷剂量右美托咪定,后分别以0.30、0.50、0.80 μg/(kg·h)速度持续静脉泵注.比较4 组手术前后血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]、脑组织损伤标志物[细胞间黏附分子-1(ICAM-1)、星形胶质源性蛋白(S-100β)]水平、蒙特利尔认知评估量表(MoCA)评分.记录 4 组术后认知障碍(POCD)发生率及不良反应发生率.结果 4 组术后1h、1d、3d血清TNF-α、IL-6、IL-10 水平均较术前升高,且D组低于A、B、C组,C组低于A、B组(P＜0.05).术后1h、1d、3d,4 组血清S-100β、ICAM-1 水平均较术前升高,且D组低于A、B、C组,C组低于A、B组(P＜0.05).术后1、3、7d,A、B组MoCA评分均较术前降低(P＜0.05);术后1、3d,C、D组MoCA评分较术前降低(P＜0.05),术后7dC、D组均恢复至术前水平;术后1、3、7dD组MoCA评分高于A、B、C组,且C组高于A、B组(P＜0.05).术后3d,D组POCD发生率低于A、B组,C组POCD发生率低于A组(P＜0.05);4 组术后低血压、心动过缓发生率比较差异无统计学意义(P＞0.05).结论 老年膝关节置换患者术中以每小时0.80 μg/kg速率持续泵入右美托咪定在减轻术后炎症损伤、神经功能损伤、认知功能损伤的效果更为显著,并能保障麻醉安全性.
Abstract
Objective To investigate the effects of Dexmedetomidine on neurologic function,cognitive function and expression of inflammatory factors in elderly patients undergoing knee arthroplasty.Methods A total of 120 elderly patients who underwent unilateral total knee arthroplasty(TKA)from March 2022 to March 2023 were selected and divided into groups A,B,C and D by random number table method,with 30 patients in each group.Group A was given combined epidural anes-thesia,while groups B,C and D were given combined epidural anesthesia plus Dexmedetomidine;0.50 μg/kg load dose of Dexmedetomidine was given after flat fixation,and then intravenous micro-pumping was continued at 0.30,0.50 and 0.80 μg/(kg·h),respectively.The levels of serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)],markers of brain tissue injury[intercellular adhesion molecule-1(ICAM-1),astroglia-derived protein(S-100β)]and Montreal Cognitive Assessment Scale(MoCA)scores before and after operation were com-pared among the four groups.The incidence of postoperative cognitive dysfunction(POCD)and adverse reactions was recor-ded in the four groups.Results The serum levels of TNF-α,IL-6 and IL-10 in the four groups at 1 h,1 d and 3 d after sur-gery were higher than those before surgery(P＜0.05).The levels of S-100β and ICAM-1 in serum of the four groups at 1 h,1 d and 3 d after surgery were higher than those before surgery,which were lower in group D than in groups A,B and C,and lower in group C than in groups A and B(P＜0.05).At 1,3 and 7 d after surgery,MoCA scores in group A and group B were lower than those before surgery(P＜0.05).At 1 and3 d after surgery,MoCA scores in groups C and D were lower than those before surgery(P＜0.05),and recovered to the preoperative level in groups C and D at 7 d after surgery.The MoCA score of group D was higher than that of groups A,B and C at 1 d,3 d and 7 d after surgery,and higher in group C than in groups A and B(P＜0.05).At 3 d after surgery,the incidence of POCD in group D was lower than that in groups A and B,and lower in group C than in group A(P＜0.05).There was no significant difference in the incidence of hypotension and bradycardia among the four groups(P＞0.05).Conclusion In elderly patients undergoing knee arthroplasty,continuous in-jection of Dexmedetomidine at a rate of 0.80 μg/(kg·h)per h during surgery has a more significant effect on reducing post-operative inflammatory injury,neurological injury and cognitive injury,and can ensure anesthesia safety.
维普
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