右美托咪定对老年患者髋关节置换围术期炎症反应和肾脏功能的影响

Effect of Dexmedetomidine on inflammatory factors and renal function in elderly patients with hip arthroplasty

摘要:

观察右美托咪定用于老年患者髋关节置换术后的治疗效果、炎症因子及肾功能的影响，为后续手术用药的选择提供依据。方法选取2013 年1 月-2015 年12 月在该院行髋关节置换术的老年患者100例，按随机数字表法分为两组，每组各50 例。实验组患者给予静脉滴注右美托咪定4μg/ml，10 min 后以0.2μg/（kg·h）+ 咪达唑仑+ 丙泊酚维持；对照组给予静脉滴注0.9%氯化钠溶液+ 咪达唑仑+ 丙泊酚。比较麻醉前、术中及术后的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、血清中的肿瘤坏死因子-α（TNF-α）、C 反应蛋白（CRP）、肌酐（Cr）、血尿素氮（BUN）浓度、血清和尿液肾损伤分子-1（KIM-1）及中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。记录并观察患者的丙泊酚用量和清醒时间、术后不良反应的发生率及术前、术后的认知能力。结果术前、术中两组患者的MAP、HR、SpO2、TNF-α、CRP 及IL-18 差异无统计学意义（p >0.05）；术后实验组的MAP 和HR 水平比较差异无统计学意义（ p>0.05）。术中、术后实验组的炎症因子表达均低于对照组且随时间的增加而增加，差异有统计学意义（ p<0.05）。术前两组患者Cr、BUN、血清、MMSE 分数、尿液中NGAL 和KIM-1 表达水平差异无统计学意义（p >0.05）；术中、术后实验组的Cr、BUN、血清、尿液中NGAL和KIM-1 表达均低于对照组且随时间的增加而增加，差异有统计学意义（ p<0.05）。实验组丙泊酚的用量、清醒时间及不良反应的发生率低于对照组而MMSE 分数相反，差异有统计学意义（ p<0.05）。结论右美托咪定用于老年人髋关节置换术具有良好的治疗效果，可抑制炎症因子的表达，不良反应发生率较低，而且对肾脏有良好的保护作用。

Abstract:

To observe the effects of Dexmedetomidine on inflammatory factors and renal function in elderly patients after hip replacement treatment so as to provide the basis for subsequent surgical medications. Methods A total of 100 cases accepting hip replacement in our hospital from January 2013 to December 2015 were selected and randomly divided into two groups according to the order of admission with 50 cases in each group. The patients in the experimental group were given 4 μg/ml intravenous infusion of Dexmedetomidine, after 10 min maintained by 0.2 μg/(kg·h) Dexmedetomidine + Midazolam + Propofol; those in the control group were given intravenous injection of 0.9% sodium chloride solution + Midazolam + Propofol. Heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), serum concentrations of tumor necrosis factor (TNF-α), C-reactive protein(CRP), creatinine (Cr) and urea nitrogen (BUN); the serum and urine levels of kidney injury molecule-1 (KIM-1),and neutrophil gelatinase associated lipocalin (NGAL) were determined before anesthesia, before and after operation and compared. The amount of Propofol and waking time were recorded, and the incidence of adverse reactions wereobserved. At the same time, the Visual Analogue Scoring System (VAS) was used to score the degree of pain after waking and 1 h after operation. The incidences of adverse reactions were observed. Results There was no significant difference in MAP, HR, SpO2, TNF-α, CRP or IL-18 between the two groups before and during surgery ( p> 0.05);postoperative MAP and HR were not significantly different ( p> 0.05). The intraoperative and postoperative expressions of inflammatory factors in the experimental group were lower than those in the control group, and the differences were statistically significant (p < 0.05). There was no statistical difference in the level of Cr or BUN, the serum and urine NGAL or KIM-1, or MMSE score before operation between the two groups (p > 0.05). The serum levels of Cr, BUN, the serum and urine levels of NGAL and KIM-1 before and after operation significantly decreased in the experimental group compared to the control group, which became more obvious with time ( p< 0.05). The Propofol dosage and the incidences of adverse reactions in the experimental group were lower than those in the the control group, the awaking time in the experimental group was shorter than that in the control group, the differences were statistically significant (p < 0.05). The postoperative MMSE score of the experimental group was significantly higher than that of the control group ( p< 0.05). Conclusions Dexmedetomidine not only has a good therapeutic effect on inflammatory factors for elderly hip replacement, but also has a protective effect on the kidneys and low incidences of adverse reactions.