摘要
目的探讨右美托咪定和亚麻醉剂量氯胺酮对老年骨科手术患者术后认知功能和苏醒质量的影响。方法回顾性分析124例行骨科手术治疗的老年患者的临床资料,根据围术期麻醉给药情况分为对照组(右美托咪定组)61例与观察组(右美托咪定联合亚麻醉剂量氯胺酮组)63例。记录2组术前、切皮时、拔管时血流动力学指标[平均动脉压(MAP)、心率(HR)]和术前、术后1、3 d认知功能[简易智力状况检查法(MMSE)],观察2组术后认知功能障碍(POCD)发生情况和苏醒时间、拔管时间、拔管时躁动[肌肉活动评分法(MAAS)]等苏醒质量指标水平,并比较术前及术后1 d免疫状态[干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)、IFN-γ/IL-4]差异。结果切皮时、拔管时,2组MAP、HR水平均较术前显著升高(P<0.05),但2组组间比较,差异无统计学意义(P>0.05)。术前、术后3 d时,2组MMSE评分比较,差异无统计学意义(P>0.05);术后1 d时,2组MMSE评分均显著低于术前及术后3 d时(P<0.05),且对照组显著低于观察组(P<0.05)。观察组术后1 d内POCD发生率及拔管时MAAS评分均显著低于对照组,苏醒时间、拔管时间显著早于对照组(P<0.05)。术后1 d时,2组IFN-γ、IL-4、IFN-γ/IL-4水平均显著高于术前(P<0.05),且观察组IFN-γ、IFN-γ/IL-4水平显著高于对照组,IL-4水平则显著低于对照组(P<0.05)。结论右美托咪定联合亚麻醉剂量氯胺酮能改善老年骨科手术患者的免疫功能与认知功能,对于改善患者苏醒质量也有积极意义。
Objective To investigate the effects of dexmedetomidine and subanesthetic dose of ketamine on postoperative cognitive function and recovery quality in the elderly with orthopedic surgery.Methods The clinical data of 124 elderly patients undergoing orthopedic surgeries was retrospectively analyzed.According to the administration of perioperative anesthesia,they were divided into control group(dexmedetomidine group,61 cases)and observation group(dexmedetomidine combined with subanesthetic dose of ketamine group,63 cases).The hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)]before surgery,at skin peeling and extubation,cognitive function evaluated by Mini-mental State Examination(MMSE)before surgery and at 1 and 3 d after surgery were recorded,occurrence of postoperative cognitive dysfunction(POCD)and awakening quality indicators such as recovery time,extubation time and agitation muscle activity evaluated by Muscle Activity Scale(MAAS)score were recorded.Besides,the differences of immune status including interferon-γ(IFN-γ),interleukin-4(IL-4),IFN-γ/IL-4 before surgery and at 1 d after surgery were compared in the two groups.Results At skin peeling and extubation,the MAP and HR in the two groups were increased compared with those before surgery(P<0.05),but there were no significant differences between the two groups(P>0.05).There were no significant differences in the MMSE scores between the two groups before surgery and at 3 d after surgery(P>0.05).At 1 d after surgery,the MMSE scores in the two groups were lower than those before surgery and at 3 d after surgery(P<0.05),and the MMSE score in the control group was lower than that in the observation group(P<0.05).The incidence rate of POCD within 1 d after surgery and MAAS score at extubation in observation group were lower,and recovery time as well as extubation time was earlier than those in control group(P<0.05).At 1d after surgery,the IFN-γ,IL-4 and IFN-γ/IL-4 levels in the two groups were higher than before surgery(P<0.05),and the observation group was higher than the control group in IFN-γand IFN-γ/IL-4(P<0.05),and IL-4 level in the observation group was lower than that in the control group(P<0.05).Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can simultaneously improve the immune function and cognitive function of elderly patients undergoing orthopedic surgery,and it is of positive significance in improving the awakening quality of patients.
作者
石川
董补怀
吴绪才
徐涛
SHI Chuan;DONG Buhuai;WU Xucai;XU Tao(First Department of Operative Anesthesia,Xi′an City Red Cross Hospital,Xi′an,Shaanxi,710054)
出处
《实用临床医药杂志》
CAS
2020年第13期87-90,95,共5页
Journal of Clinical Medicine in Practice
基金
陕西省卫生厅科研基金项目(2017D10670)。
关键词
氯胺酮
亚麻醉剂量
右美托咪定
骨科手术
老年患者
认知功能
ketamine
subanesthetic dose
dexmedetomidine
orthopedic surgery
elderly patients
cognitive function
