右美托咪定辅助全身麻醉对老年股骨颈骨折患者血清T淋巴细胞亚群水平的影响(1)
[摘要] 目的 探討右美托咪定辅助全身麻醉对老年股骨颈骨折患者血清T淋巴细胞亚群水平的影响。 方法 选取2017年2月～2019年1月宁波大学医学院附属医院86例股骨颈骨折老年患者，择期行全身麻醉下髋关节置换术，依据麻醉方案不同将其分为观察组和对照组，每组各43例。观察组于麻醉诱导前予以0.5 μg/kg右美托咪定，经静脉输液泵注射;对照组于麻醉诱导前予以等容量生理盐水，经静脉输液泵注射。两组分别于给药前(T0)、给药10 min(T1)、气管插管即刻(T2)、手术切皮(T3)、手术进行30 min(T4)、术毕(T5)、气管插管拔除后5 min(T6)、气管插管拔除后30 min(T7)监测患者心率(HR)、平均动脉压(MAP);采用流式细胞仪检测术前和术后1、3 d外周血中CD3+、CD4+、CD8+、CD4+/CD8+;采用简易精神状态量表(MMSE)评估术前和术后1、3、7 d认知功能，并统计术中丙泊酚、芬太尼用量及不良反应发生率。 结果 观察组T2、T6时间点的HR、MAP均低于对照组(P < 0.05);观察组术中芬太尼、丙泊酚用量少于对照组(P < 0.05);观察组术后1、3 d外周血中CD3+、CD4+、CD4+/CD8+水平高于对照组，CD8+水平低于对照组(P < 0.05);观察组术后1、3、7 d的认知功能评分高于对照组(P < 0.05);两组不良反应发生率比较，差异无统计学意义(P > 0.05)。 结论 右美托咪定辅助全身麻醉应用于老年股骨颈骨折患者，有助于减少其术中麻醉药物用量，维持围术期血流动力学稳定，且对患者T淋巴亚群细胞及认知功能影响较小，安全性高。
[关键词] 股骨颈骨折;全身麻醉;右美托咪定;T淋巴细胞亚群;血流动力学;认知功能
[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210(2019)06(c)-0154-05
Effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture
XU Yiguo WU Xiang LI Hongbao ZHU Binbin ZHU Wei
Department of Anesthesiology， the Affiliated Hospital of Medical School of Ningbo University， Zhejiang Province， Ningbo 315211， China
[Abstract] Objective To explore the effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture. Methods From February 2017 to January 2019， 86 elderly patients with femoral neck fracture from the Affiliated Hospital of Medical School of Ningbo University were selected to undergo hip replacement under general anesthesia. They were divided into observation group and control group according to different anesthesia schemes， with 43 cases in each group. The observation group was given 0.5 μg/kg Dexmedetomidine before induction of anesthesia and injected by intravenous infusion pump. The control group was given normal saline of equal volume before induction of anesthesia and injected by intravenous infusion pump. Heart rate (HR) and mean arterial pressure (MAP) were monitored before administration (T0)， 10 minutes after administration (T1)， immediately after tracheal intubation (T2)， skin incision (T3)， 30 minutes after operation (T4)， 5 minutes after tracheal intubation (T6)， 30 minutes after tracheal intubation (T7). Flow cytometry was used to detect the levels of CD3+， CD4+， CD8+， CD4+/CD8+ in peripheral blood before and 1 d after surgery. Cognitive function was assessed before and after 1， 3， 7 days by mini-mental state examination (MMSE)， and the amount of Propofol and Fentanyl during operation and the incidence of adverse reactions were counted. Results The HR and MAP of T2 and T6 in the observation group were lower than those in the control group (P < 0.05); Fentanyl and Propofol used in the observation group were less than those in the control group (P < 0.05); CD3+， CD4+， CD4+/CD8+ of peripheral blood in the observation group were higher than those in the control group at 1 and 3 days after operation， and CD8+ level was lower than that in the control group (P < 0.05). Cognitive function score in the observation group were higher than that in the control group at 1， 3 and 7 days after operation (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion The application of Dexmedetomidine-assisted general anesthesia in elderly patients with femoral neck fracture is helpful to reduce the amount of anesthetics used during the operation and maintain the stability of perioperative hemodynamics. It has little effect on T lymphocyte subsets and cognitive function， with high safety., 百拇医药(徐义国 吴祥 李红宝 朱斌斌 朱伟)
[关键词] 股骨颈骨折;全身麻醉;右美托咪定;T淋巴细胞亚群;血流动力学;认知功能
[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210(2019)06(c)-0154-05
Effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture
XU Yiguo WU Xiang LI Hongbao ZHU Binbin ZHU Wei
Department of Anesthesiology， the Affiliated Hospital of Medical School of Ningbo University， Zhejiang Province， Ningbo 315211， China
[Abstract] Objective To explore the effect of Dexmedetomidine-assisted general anesthesia on serum T lymphocyte subsets in elderly patients with femoral neck fracture. Methods From February 2017 to January 2019， 86 elderly patients with femoral neck fracture from the Affiliated Hospital of Medical School of Ningbo University were selected to undergo hip replacement under general anesthesia. They were divided into observation group and control group according to different anesthesia schemes， with 43 cases in each group. The observation group was given 0.5 μg/kg Dexmedetomidine before induction of anesthesia and injected by intravenous infusion pump. The control group was given normal saline of equal volume before induction of anesthesia and injected by intravenous infusion pump. Heart rate (HR) and mean arterial pressure (MAP) were monitored before administration (T0)， 10 minutes after administration (T1)， immediately after tracheal intubation (T2)， skin incision (T3)， 30 minutes after operation (T4)， 5 minutes after tracheal intubation (T6)， 30 minutes after tracheal intubation (T7). Flow cytometry was used to detect the levels of CD3+， CD4+， CD8+， CD4+/CD8+ in peripheral blood before and 1 d after surgery. Cognitive function was assessed before and after 1， 3， 7 days by mini-mental state examination (MMSE)， and the amount of Propofol and Fentanyl during operation and the incidence of adverse reactions were counted. Results The HR and MAP of T2 and T6 in the observation group were lower than those in the control group (P < 0.05); Fentanyl and Propofol used in the observation group were less than those in the control group (P < 0.05); CD3+， CD4+， CD4+/CD8+ of peripheral blood in the observation group were higher than those in the control group at 1 and 3 days after operation， and CD8+ level was lower than that in the control group (P < 0.05). Cognitive function score in the observation group were higher than that in the control group at 1， 3 and 7 days after operation (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion The application of Dexmedetomidine-assisted general anesthesia in elderly patients with femoral neck fracture is helpful to reduce the amount of anesthetics used during the operation and maintain the stability of perioperative hemodynamics. It has little effect on T lymphocyte subsets and cognitive function， with high safety., 百拇医药(徐义国 吴祥 李红宝 朱斌斌 朱伟)