目的:探讨右美托咪定辅助麻醉对老年阿尔茨海默病(AD)患者髋关节置换术(THR)炎症因子及T淋巴细胞亚群的影响。方法:选取我院收治的AD患者实施THR60例为研究对象,随机分为观察组和对照组各30例,两组患者严格术前准备,咪唑安定0.04 mg/kg静脉注射,丙泊酚0.5~1.5 mg/kg、顺阿曲库胺0.15 mg/kg、芬太尼4 μg/kg进行诱导麻醉,丙泊酚1.5~2.5 mg/(kg·h)持续静脉泵注,瑞芬太尼0.04~0.4 μg/(kg·min)维持麻醉深度,顺阿曲库铵间断松肌,观察组于麻醉诱导气管插管开始时15 min右美托咪定1 μg/kg静脉泵注,再以0.2~0.7 μg/(kg·h)维持至手术结束。采集术前、术毕即刻、术后12 h、术后24 h外周静脉血,采用ELISA法测定C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平；采用流式细胞仪测定T淋巴细胞亚群(CD3+、CD4+、CD8+)水平,计算CD4+/CD8+值；采用Ramsay镇静评分进行术前、术毕即刻、术后12 h、术后24 h评分。结果:观察组术毕即刻、术后12 h Ramsay镇静评分大于同期对照组(P<0.05)；观察组术后即刻、术后12 h、术后24 h血清CRP、IL-6、TNF-α水平低于同期对照组(P<0.05)；观察组术后即刻、术后12 h、术后24 h血清CD3+、CD4+、CD8+水平及CD4+/CD8+值均高于同期对照组(P<0.05)。结论:右美托咪定对AD患者实施THR具有独特的镇痛、镇静作用,可有效抑制炎症因子的释放,从而改善机体免疫功能。
Objective: To explore the effect of dexmedetomidine assisted anesthesia on the inflammatory cytokines and T lymphocyte subsets in elderly patients with Alzheimer disease (AD) underwent total hip replacement (THR). Methods: A total of 60 patients with AD who were admitted in our hospital from October 2014, to October 2016 for THR were included in the study and randomized into the observation group and the control group with 30 cases in each group. Strict preoperative preparation was performed. The patients in the two groups were given intravenous injection of midazolam (0.04 mg/kg), propofol (0.5~1.5) mg/kg, cisatracurium (0.15 mg/kg), and fentanyl (4 μg/kg) for anesthesia induction, continuously venous pumping of propofol (1.5~2.5) mg/kg/h and remifentanil (0.04~0.40) μg/kg/min in maintaining the anesthesia depth, and cisatracurium for intermittent muscle relaxation. The patients in the observation group were given venous pumping of dexmedetomidine (1 μg/kg) 15 min before anesthesia induction, and dexmedetomidine (0.2~0.7) μg/kg/h for maintenance until the end of operation. The peripheral venous blood before operation, the time immediately after operation, 12 h and 24 h after operation in the two groups was collected. ELISA was used to detect CRP, IL-6, and TNF-α. FCM was used to detect T lymphocyte subsets (CD3+, CD4+, and CD8+). CD4+/CD8+ were calculated. Ramsay sedation grading was performed before operation, the time immediately after operation, 12 h and 24 h after operation. Results: Ramsay sedation score the time immediately after operation and 12 h after operation in the observation group was significantly greater than that in the control group (P<0.05). The serum CRP, IL-6, and TNF-α levels the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly lower than those in the control group (P<0.05). The serum CD3+, CD4+, CD8+, and CD4+/CD8+ the time immediately after operation, 12 h and 24 h after operation in the observation group were significantly higher than those in the control group (P<0.05). Conclusions: Dexmedetomidine applied in patients with AD underwent THR has a unique analgesia and sedation effect, and can effectively inhibit the release of inflammatory cytokines in order to improve the immunological function.