右美托咪定对腰椎手术术中自体血回输患者Fbg、RDW及hs-CRP水平的影响

Effects of dexmedetomidine on fibrinogen, red cell distribution width, and high-sensitivity C-reactive protein levels in patients undergoing lumbar spine surgery with intraoperative autologous blood transfusion

摘要:

目的 探讨右美托咪定对腰椎手术术中自体血回输患者纤维蛋白原（Fbg）、红细胞分布宽度（RDW）及高敏C反应蛋白（hs-CRP）水平的影响。方法 选取2021年1月—2023年12月在沧州市中心医院行腰椎手术患者100例，并随机分为观察组和对照组，每组50例。对照组采用常规麻醉方式，观察组采用常规麻醉加右美托咪定。记录两组患者麻醉诱导前（T₀）、给药后15 min（T₁）、手术结束时（T₂）和术后2 h（T₃）时血流动力学指标［心率（HR）、平均动脉压（MAP）］。比较两组患者术后6、12和24 h的视觉模拟评分法（VAS）和简易精神状态检查量表（MMSE）评分。比较两组患者手术前后的实验室指标［肿瘤坏死因-α（TNF-α）、白细胞介素-6（IL-6）、高敏C反应蛋白（hs-CRP）］、凝血功能指标［纤维蛋白原（Fbg）、凝血酶原时间（PT）］、红细胞分布宽度（RDW）变异系数］及术后并发症发生率。结果 两组患者T₀、T₁、T₂、T₃的HR、MAP比较，结果 ①不同时间点HR、MAP比较，差异均有统计学意义（F =187.730和165.271，均P <0.05）；②两组患者HR、MAP比较，差异均有统计学意义（F =77.940和104.127，均P <0.05）；③两组患者HR、MAP变化趋势比较，差异均有统计学意义（F =8.179和9.019，均P <0.05）。两组患者术后6、12和24 h的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =458.399，P <0.05）；②两组患者VAS评分比较，差异有统计学意义（F =58.241，P <0.05），观察组VAS评分较对照组低，相对镇痛效果较好；③两组患者VAS评分变化趋势比较，差异有统计学意义（F =3.493，P <0.05）。两组患者术后6、12和24 h的MMSE评分比较，结果 ①不同时间点MMSE评分比较，差异有统计学意义（F =433.366，P <0.05）；②两组患者MMSE评分比较，差异有统计学意义（F =162.686，P <0.05），观察组MMSE评分较对照组高，相对认知功能较好；③两组患者VAS评分变化趋势比较，差异有统计学意义（F =36.945，P <0.05）。观察组手术前后TNF-α、IL-6、hs-CRP、Fbg、PT、RDW的差值均低于对照组（P <0.05）。观察组术后并发症总发生率低于对照组（P <0.05）。结论 右美托咪定联合自体血回输在腰椎手术中能有效改善血流动力学，减轻炎症反应和术后疼痛，提高认知功能，同时降低术后并发症的风险。

Abstract:

Objective To explore the effects of dexmedetomidine on the levels of fibrinogen (Fbg), red cell distribution width (RDW), and high-sensitivity C-reactive protein (hs-CRP) in patients undergoing lumbar spine surgery with intraoperative autologous blood transfusion.Methods The 100 patients requiring lumbar surgery in Cangzhou Central Hospital from January 2021 to December 2023 were selected, and were randomly divided into the observation group and the control group, with 50 cases in each group. The control group received conventional anesthesia, while the observation group received conventional anesthesia combined with dexmedetomidine. Hemodynamic parameters [heart rate (HR) and mean arterial pressure (MAP) ] were recorded before anesthesia induction (T₀), 15 minutes after drug administration (T₁), at the end of the surgery (T₂), and 2 hours after surgery (T₃). Visual Analog Scale (VAS) and Mini-Mental State Examination (MMSE) scores 6, 12, and 24 hours after surgery were compared between the two groups. Laboratory indicators including inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) ], coagulation function indicators [fibrinogen (Fbg), and prothrombin time (PT) ], and red blood cell distribution width (RDW) coefficient of variation before and after surgery, and incidence of postoperative complications were compared between the two groups.Results Comparison of HR and MAP at T₀, T₁, T₂, and T₃ between the observation group and the control group showed significant differences in HR and MAP among different time points (F = 187.730 and 165.271, both P < 0.05) and between the two groups (F = 77.940 and 104.127, both P < 0.05), and significant differences in the change trends of HR and MAP between the two groups (F = 8.179 and 9.019, both P < 0.05). Comparison of VAS scores 6, 12, and 24 hours after surgery between the observation group and the control group showed significant differences in VAS scores among different time points (F = 458.399, P <0.05) and between the groups (F = 58.241, P < 0.05). The VAS scores in the observation group were lower than those in the control group, indicating better analgesic effects. There were also significant differences in the change trend of VAS scores between the two groups (F = 3.493, P < 0.05). Comparison of MMSE scores 6, 12, and 24 hours after surgery between the observation group and the control group showed significant differences in MMSE scores among different time points (F = 433.366, P < 0.05) and between the groups (F = 162.686, P < 0.05). The MMSE scores in the observation group were higher than those in the control group, indicating better cognitive function. There were significant differences in the change trend of MMSE scores between the two groups (F = 36.945, P < 0.05). The differences of levels of TNF-α, IL-6, hs-CRP, and Fbg, PT, and RDW before and after treatment were lower in the observation group compared to the control group (P < 0.05). The overall incidence of postoperative complications in the observation group was lower than that in the control group (P < 0.05).Conclusions Dexmedetomidine combined with autologous blood transfusion can effectively improve hemodynamics, reduce inflammatory responses and postoperative pain, enhance cognitive function, and lower the risk of postoperative complications in lumbar spine surgery.