右美托咪定對老年髖關節置換術患者炎性因子及腎功能的影響

李雪丹 黃柯冰 黃杰等

[摘要] 目的 觀察右美托咪定用于老年患者髖關節置換術對炎性因子及腎功能的影響，為老年髖關節置換手術麻醉鎮靜用藥的選擇提供依據。 方法 選取2015年9月～2017年12月在陜西省漢中市中心醫院行髖關節置換術的老年患者200例，按隨機數字表法分為實驗組與對照組，每組各100例。實驗組患者給予靜脈滴注右美托咪定1 μg/kg，10 min后以0.2 μg/（kg·h）+丙泊酚維持;對照組給予靜脈滴注0.9%氯化鈉溶液+丙泊酚。比較兩組患者麻醉前（T0）、切皮時（T1）、手術結束即刻（T2）、術后6 h（T3）患者的心率（HR）、平均動脈壓（MAP），及血清中的腫瘤壞死因子-α（TNF-α）、白介素-6（IL-6）、C反應蛋白（CRP）、肌酐（Cr）和血尿素氮（BUN）水平變化。記錄并觀察患者蘇醒期的不良反應發生率及T0、T3時的Ramsay鎮靜評分。 結果 實驗組在T1、T2和T3時間點MAP和HR水平以及炎性因子TNF-α、CRP及IL-6水平均顯著低于對照組（P < 0.05）。T1、T2、T3時間點實驗組的Cr和BUN水平均低于對照組，差異有統計學意義（P < 0.05）。實驗組不良反應發生率低于對照組，而Ramsay評分則高于對照組，差異有統計學意義（P < 0.05）。 結論 右美托咪定應用于老年髖關節置換術可以抑制炎性因子的表達，對腎臟具有一定的保護作用，可以作為老年人髖關節置換術的麻醉輔助用藥。

[關鍵詞] 右美托咪啶;髖關節;炎性因子;腎功能;老年人;鎮靜

[中圖分類號] R68? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）02（a）-0104-04

[Abstract] Objective To observe the effects of Dexmedetomidine on inflammatory factors and renal function in elderly patients after hip replacement treatment， and to provide basis for selection of anesthetic sedative medication for elderly patients undergoing hip replacement surgery. Methods A total of 200 elderly patients accepted hip replacement in Hanzhong Central Hospital of Shaanxi Province from September 2015 to December 2017 were selected and divided into experimental group and control group according to the random number table method， with 100 cases in each group. The patients in the experimental group were given 1 μg/kg intravenous infusion of Dexmedetomidine， after 10 min， the patients were maintained by 0.2 μg/（kg·h） Dexmedetomidine +Propofol; the control group were given intravenous injection of 0.9% sodium chloride solution + Propofol. Before anesthesia （T0）， skin incision （T1）， surgical （T2）， the end of the postoperative 6 h （T3）， the heart rate （HR）， mean arterial pressure （MAP）， and the serum tumor necrosis factor alpha （TNF-α）， interleukin 6 （IL-6）， c-reactive protein （CRP）， creatinine （Cr） and blood urea nitrogen （BUN） level changes of the two groups were compared. The incidence of adverse reactions during the recovery period and the Ramsay sedation score at T0 and T3 were recorded and observed. Results The levels of MAP and HR as well as the levels inflammatory factors TNF-α， CRP and IL-6 at T1， T2 and T3 in the experimental group were significantly lower than those in the control group （P < 0.05）. At T1， T2 and T3 time points， the levels of Cr and BUN in the experimental group was lower than that in the control group， and the differences were statistically significant （P < 0.05）. The incidence of adverse reactions in the experimental group was lower than that in the control group， and Ramsay score was higher than that in the control group， with statistically significant differences （P < 0.05）. Conclusion The application of Dexmedetomidine in elderly hip replacement can inhibit the expression of inflammatory factors and protect the kidneys， which can be used as an auxiliary anesthetic for hip replacement in the elderly.

[Key words] Dexmedetomidine; Hip replacement; Inflammatory factors; Renal function; Elderly; Sedation

隨著我國人口老齡化越來越嚴重，骨質疏松和生活方式所致的髖部骨折發生率明顯增加，老年髖關節置換手術的數量也與日俱增。髖關節置換手術不僅能夠有效地解除髖關節疼痛、保持關節的活動度和穩定性，還可以提高患者的生命質量[1]。手術操作能夠引起機體的應激反應水平升高和炎性因子釋放增加，而老年人常常合并高血壓、糖尿病、認知功能改變等慢性疾病，術后容易造成各種并發癥從而影響預后[2-3]。右美托咪定是一種新型的高選擇性的α2腎上腺能受體激動劑，具有鎮靜、鎮痛、抗焦慮、穩定血流動力學等作用，且最新研究發現其還具有抗炎和腎保護作用，對于減輕圍術期的應激反應和炎性因子釋放可能具有一定的作用[4-6]。……