右美托咪定对老年髋关节置换患者术后应激反应和短期认知功能的影响

目的研究右美托咪定对老年髋关节置换患者术后短时间内认知功能和炎症细胞因子的影响。方法选取我院2014年6月至2016年1月收治的72例老年髋关节置换手术患者采用随机数字法将其分为对照组和观察组,每组36例手术麻醉诱导前,给予观察组患者静脉滴注右美托咪定治疗对照组患者静脉滴注等容量生理盐水作为对照。比较两组患者的认知功能变化、镇静评分、炎症细胞因子水平、血清S100β蛋白水平等指标变化。结果对照组术后1、3、7 d的简易精神量表(MMSE)评分均明显低于术前1 d和观察组(P<0.01);观察组T_1~T_5时的Ramsay镇静评分均明显高于T_0时和对照组(P<0.05);对照组T_2~T_5时的IL-6、IL-1β、TNF-α水平均明显高于T_0、T_1时及观察组(P<0.01),T_1、T_2时两组血清S100β蛋白水平达到最高值,与T_0时比较差异有统计学意义(P<0.05),且观察组明显低于对照组(P<0.05)。结论右美托咪定能明显降低老年患者髋关节置换术后认知功能障碍的发生率,可避免产生不良情绪,同时降低炎症细胞因子及血清S100β蛋白水平,减轻炎症反应,其疗效显著且安全性高,值得在临床中推广。

Effect of dexmedetomidine on stress response and short-term cognitive function in elderly patients undergoing hip joint replacement surgery

Objective To study the influence of dexmedetomidine on stress response and short-term cognitive function in elderly patients undergoing hip joint replacement surgery. Methods Totally 72 patients with hip replace-ment who were admitted to our hospital from June 2014 to January 2016 were selected. They were randomly divided in-to observation group and in control group,36 cases in each group. Before induction of anesthesia,observation group was given intravenous infusion of dexmedetomidine,while control group received equal volume of saline intravenously as a control. The cognitive function,sedation scores,changes in inflammatory cytokine levels and serum protein S100β of the two groups were compared. Results The MMSE scores of control group at 1,3,7 d after surgery were significantly lower than those at 1 d before surgery and observation group(P<0. 01);the Ramsay sedation score of patients in ob-servation group at T1 ~T5 was obviously higher than that at T0 and control group (P <0. 05). The IL-6,IL-1β and TNF-α levels of control group at T2 ~T5 were higher than those at T0 and T2 and in control group (P<0. 01). The ser-um S100β protein levels were the highest at T1 and T2 in each group,which were higher than that at T0(P<0. 05),and the levels in observation group was obviously lower than those of control group (P<0. 05). Conclusion Dexmedeto-midine can significantly reduce the incidence of cognitive dysfunction and prevent the occurrence of negative emotions, mean while,it can reduce the inflammatory cytokines and serum S100β protein levels,and alleviate the inflammatory rection of elderly patients after hip replacement surgery with obvious curative effect and high safety,it is worthy of clin-ical promotion.