2019 年第 1 期 第 14 卷

右美托咪定辅助全身麻醉对老年下肢骨折患者镇痛效果及术后认知功能和免疫功能的影响

Effect of general anesthesia plus dexmedetomidine on analgesia, postoperative cognitive function and immunity in elderly patients with lower limb fracture

作者：李晓明李俊李德奎何周霞卢士学

英文作者：

单位：237003安徽省六安市第二人民医院麻醉科

英文单位：

关键词：下肢骨折；右美托咪定；认知功能；免疫；镇痛

英文关键词：

• 摘要：

• 【摘要】目的    评估右美托咪定辅助全身麻醉对老年下肢骨折患者镇痛效果及术后认知功能、免疫功能的影响。方法    选取2017年6月至2018年6月安徽省六安市第二人民医院收治的70例全身麻醉下行下肢骨折手术老年患者作为研究对象，根据随机数字表法分为观察组和对照组，各35例。对照组采用常规全身麻醉，观察组气管插管后15 min静脉输注盐酸右美托咪定1 μg/kg，再以0.2～0.6 μg/(kg·h)维持至手术结束前30 min。采用疼痛视觉模拟量表（VAS）评估镇痛效果；采用简易精神状态评价量表（MMSE）评估患者认知功能；采用流式细胞学方法检测血清CD+3、CD+4、CD+8含量及CD+4/CD+8比值；观察术后48 h内2组患者并发症发生情况。结果    观察组患者术后1、2、4、6、8、10、12、14、16、18、20、24 h的VAS评分均低于对照组（均P＜0.01）。观察组术后1、2、7 d的MMSE评分均明显高于对照组（均P＜0.05）。术后7 d时观察组术后认知功能障碍（POCD）发生率明显低于对照组［2.9%（1/35）比17.1%（6/35）］（P＝0.046）。观察组术后6、24、48 h的CD+3、CD+4、CD+4/CD+8均明显高于对照组（均P＜0.05）。观察组术后48 h总并发症发生率明显低于对照组［17.1%（6/35）比57.1%（20/35）］（P＝0.001）。结论    右美托咪定辅助全身麻醉镇痛效果较好，可改善老年下肢骨折患者术后认知功能，降低术后免疫功能抑制，改善免疫功能，降低POCD及术后并发症发生率。

• 【Abstract】Objective    To analyze the effect of general anesthesia plus dexmedetomidine on analgesia, postoperative cognitive function and immunity in elderly patients with lower limb fracture. Methods    Seventy elderly patients undergoing lower limb fracture surgery from June 2017 to June 2018 in Lu′an Second People′s Hospital of Anhui Province were randomly divided into observation group(n＝35) and control group(n＝35). The control group had general anesthesia. The observation group had general anesthesia plus intravenous administration of dexmedetomidine hydrochloride（1 μg/kg） 15 min after endotracheal intubation, and then maintained with 0.2-0.6 μg/(kg·h) until 30 min before the end of operation. Analgesia effect was analyzed by Visual Analogue Scale（VAS）. Cognitive function was assessed by Mini-Mental State Scale(MMSE). Serum levels of CD+3, CD+4, CD+8 and CD+4/CD+8 were tested by flow cytometry. Postoperative 48 h complications were observed. Results    VAS pain scores at 1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 24 h after operation in the observation group were significantly lower than those in the control group(P＜0.01). MMSE scores at 1, 2, 7 d after operation in the observation group were significantly higher than those in the control group（P＜0.05）. Incidence of postoperative cognitive dysfunction（POCD） in 7 d in the observation group was significantly lower than that in the control group［2.9%（1/35） vs 17.1%（6/35）］（P＝0.046）. Levels of CD+3, CD+4 and CD+4/CD+8 at 6, 24, 48 h after operation in the observation group were significantly higher than those in the control group(P＜0.05). Total incidence of complications in the observation group was significantly lower than that in the control group［17.1%（6/35） vs 57.1%（20/35）］（P＝0.001）. Conclusion    General anesthesia assisted with dexmedetomidine can enhance the analgesia effect and alleviate cognitive impairment, improve immune function, reduce POCD and postoperative complications in elderly patients undergoing lower limb fracture surgery.