| 右美托咪定对老年患者股骨头置换术后炎症因子及认知功能的影响 |
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Received:July 05, 2018
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| 期刊信息：《中国骨伤》2018年31卷，第12期，第1091-1095页 |
| DOI：10.3969/j.issn.1003-0034.2018.12.003 |
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目的：分析右美托咪定对老年股骨头置换术患者术后炎症因子及认知功能的影响。
方法：将2016年1月至2017年12月行股骨头置换术的老年患者（年龄≥ 60岁，ASA分级Ⅰ-Ⅱ级）60例分为3组，每组20例。所有患者接受注射咪达唑仑、芬太尼、依托咪酯、顺阿曲库铵麻醉诱导及吸入七氟醚麻醉维持。术中静吸复合维持先给予1.0 μg/kg右美托咪定的负荷量10 min，维持量根据分组分别为右美托咪定0.3 μg·kg-1·h-1（B组）和0.6 μg·kg-1·h-1（C组）泵注，A组以相同方式给予等量生理盐水。比较3组拔管、清醒、恢复时间，简易智能精神状态评分（MMSE）及术后认知功能障碍发生率，白细胞介素-6（IL-6）、白细胞介素-10（IL-10）及S100β蛋白水平等。
结果：3组患者自主呼吸恢复时间、睁眼时间及气管拔管时间、丙泊酚用量比较差异有统计学意义（P<0.05）。术后第1、3、7天，B、C组MMSE评分与A组比较，差异有统计学意义（P<0.05），且C组高于B组（P<0.05）。C组术后认知功能障碍发生率为0.0%（0/20），不良反应发生率为30.0%（6/20），A组分别为25.0%（5/20）、0.0%（0/20），B组分别为5.0%（1/20）、10.0%（2/20），差异均有统计学意义（P<0.05）。麻醉诱导前，3组IL-6、IL-10及S100β蛋白水平比较差异无统计学意义（P>0.05）；术后1 h，B、C组IL-6、IL-10及S100β蛋白水平与A组比较，差异有统计学意义（P<0.05），且C组IL-6、S100β蛋白显著低于B组（P<0.05），IL-10显著高于B组（P<0.05）。
结论：对于股骨头置换术老年患者，右美托咪定能够降低炎症因子水平及丙泊酚使用量，术后认知功能障碍发生率低，且呈现剂量依赖性，但是需根据患者情况选择合适剂量。 |
| [关键词]:右美托咪定 股骨头假体 关节成形术,置换,髋 老年人 认知功能 |
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| Effect of dexmedetomidine on inflammatory factors level and cognitive function after femoral head replacement in elderly patients |
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Abstract:
Objective: To analyze the effect of dexmedetomidine on the inflammatory factors level and cognitive function after femoral head replacement in elderly patients.
Methods: From January 2016 to December 2017,60 elderly patients(more than 60 years old,and GradeⅠtoⅡof ASA) treated with femoral head replacement were divided into three groups,and 20 in each group. All patients received midazolam,fentanyl,etomidate,cisatracurium anesthesia induction and sevoflurane inhalation anesthesia maintenance. The patients in group B and group C were first given 1.0 μg/kg of dexmedetomidine 10 minutes during the operation. The maintenance volume was 0.3 μg·kg-1·h-1 of dexmedetomidine(in group B) and 0.6 μg·kg-1·h-1 of dexmedetomidine(in group C) by pumping. The same amount of saline was given to the patients in group A in the same way. The time of extubation,wakefulness and recovery,the simple intelligent mental state score (MMSE),the incidence of postoperative cognitive dysfunction (POCD) and the levels of interleukin-6 (IL-6),interleukin-10 (IL-10) and S100β protein expression in the 3 groups were compared.
Results: There were significant differences in the time of spontaneous breathing recovery,eye opening tome and the time of extubation,as well as the dosage of propofol among the three groups(P<0.05). On the 1st,3rd and 7th day after operation,there was a significant difference in MMSE score of group B and group C compared with that of group A(P<0.05),and MMSE score in group C was significantly higher than that of group B(P<0.05). The incidence of POCD was 0.0% (0/20) and the incidence of adverse reactions was 30%(6/20) in group C,but those were 25% (5/20) and 0.0% (0/20) in group A and 5% (1/20) and 10% (2/20) respectively in group B. The difference was statistically significant (P<0.05). Before induction of anesthesia,there was no significant difference in the levels of IL-6,IL-10 and S100β protein among the three groups(P>0.05);but one hour after the operation,the levels of IL-6 IL-10 and S100β protein in group B and group C was statistically different from those in group A(P<0.05). The IL-6 and S100β protein in group C were significantly lower than those in group B (P<0.05),and IL-10 was significantly higher than that in group B (P<0.05).
Conclusion: For elderly patients operated for femoral head replacement,dexmedetomidine can reduce the level of inflammatory factors level and propofol consumption,and the incidence of postoperative POCD is low,indicating a dose dependence of dexmedetomidine. But it is necessary to choose the right dose according to the patient's condition. |
| KEYWORDS:Dexmedetomidine Femoral head prosthesis Arthroplasty,replacement,hip Elderly Cognitive function |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黎贤泰,江晓敏,郑志远,黄焕森.右美托咪定对老年患者股骨头置换术后炎症因子及认知功能的影响[J].中国骨伤,2018,31(12):1091~1095 |
| 英文格式: | LI Xian-tai,JIANG Xiao-min,ZHENG Zhi-yuan,HUANG Huan-sen.Effect of dexmedetomidine on inflammatory factors level and cognitive function after femoral head replacement in elderly patients[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(12):1091~1095 |
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