2025 年第 10 期 第 20 卷

右美托咪定联合羟考酮在经皮椎间孔镜腰椎间盘切除术中的麻醉效果及对患者炎症反应和氧化应激的影响

The anesthetic effect of dexmedetomidine combined with oxycodone in percutaneous transforaminal endoscopic lumbar discectomy and its effect on inflammatory response and oxidative stress of patients

作者：陈婷婷戴晓雯王江

英文作者：Chen Tingting Dai Xiaowen Wang Jiang

单位：新疆医科大学第一附属医院麻醉科，乌鲁木齐830000

英文单位：Department of Anesthesiology The First Affiliated Hospital of Xinjiang Medical University Urumqi 830000 China

关键词：腰椎间盘突出症；右美托咪定；羟考酮；经皮椎间孔镜腰椎间盘切除术；平均动脉压；心率；炎症反应；氧化应激

英文关键词：Lumbardischerniation;Dexmedetomidine;Oxycodone;Percutaneoustransforaminalendoscopiclumbardiscectomy;Meanarterialpressure;Heartrate;Inflammatoryresponse;Oxidativestress

• 摘要：

• 目的 探讨右美托咪定联合羟考酮对经皮椎间孔镜腰椎间盘切除术（PELD）患者平均动脉压（MAP）、心率、炎症反应和氧化应激的影响。方法 随机选取2024年1月至2025年1月新疆医科大学第一附属医院收治的100例行PELD的腰椎间盘突出症（LDH）患者，按随机数字表法分为对照组和观察组，各50例。对照组麻醉诱导前静脉注射羟考酮，观察组麻醉诱导前静脉注射羟考酮联合右美托咪定。比较2组患者不同时点的MAP、心率、视觉模拟量表（VAS）评分、炎症反应指标［白细胞介素1β（IL-1β）、IL-8、IL-6、肿瘤坏死因子α（TNF-α）］、氧化应激指标［丙二醛、超氧化物歧化酶（SOD）］水平和不良反应。结果 观察组患者T2～T5的MAP和心率均明显低于对照组（均P<0.05）。观察组患者术后1、12和24 h的VAS评分均明显低于对照组［（3.0±0.5）分比（3.7±0.5）分、（2.1±0.4）分比（2.6±0.5）分、（1.5±0.3）分比（2.2±0.5）分］（均P<0.05）。观察组患者术后1、2和3 d的炎症反应指标及术后1、2 d的丙二醛水平均明显低于对照组，术后1、2 d的SOD水平均明显高于对照组（均P<0.05）。2组不良反应发生率比较差异无统计学意义（P=0.674）。结论 右美托咪定联合羟考酮应用于LDH患者PLED术中的麻醉效果良好，能够有效改善患者的MAP、心率，降低术后疼痛感，抑制炎症反应和氧化应激反应。

• Objective To investigate the effects of dexmedetomidine combined with oxycodone on mean arterial pressure (MAP), heart rate, inflammatory response and oxidative stress in patients undergoing percutaneous transforaminal endoscopic lumbar discectomy (PELD). Methods A total of 100 patients with lumbar disc herniation (LDH) who underwent PELD in The First Affiliated Hospital of Xinjiang Medical University from January 2024 to January 2025 were randomly selected. According to the random number table method, they were divided into the control group and the observation group, with 50 cases in each group. The control group was intravenously injected with oxycodone before anesthesia induction, and the observation group was intravenously injected with oxycodone combined with dexmedetomidine before anesthesia induction. MAP, heart rate, visual analogue scale (VAS) score, inflammatory response indicators ［interleukin-1β (IL-1β), IL-8, IL-6, tumor necrosis factor-α (TNF-α)］, oxidative stress indicators ［malondialdehyde, superoxide dismutase (SOD)］ and adverse reactions were compared between the two groups at different time points. Results The MAP and heart rate of the observation group during T2 to T5 were significantly lower than those of the control group (all P<0.05). The VAS scores of the observation group at 1, 12, and 24 h after surgery were significantly lower than those of the control group ［(3.0±0.5) vs (3.7±0.5), (2.1±0.4) vs (2.6±0.5), (1.5±0.3) vs (2.2±0.5)］(all P<0.05). The inflammatory response indexes of the observation group at 1, 2 and 3 d after operation and the malondialdehyde levels at 1 and 2 d after operation were significantly lower than those of the control group, and the SOD levels at 1 and 2 d after operation were significantly higher than those of the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.674). Conclusion Dexmedetomidine combined with oxycodone has a good anesthetic effect in PLED surgery of LDH patients, which can effectively improve the MAP and heart rate of patients, reduce postoperative pain, and inhibit inflammatory response and oxidative stress.