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右美托咪定对老年髋关节置换术患者炎性因子及肾功能的影响 预览

Effect of Dexmedetomidine on inflammatory factors and renal function in elderly patients undergoing hip replacement surgery
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摘要 目的观察右美托咪定用于老年患者髋关节置换术对炎性因子及肾功能的影响,为老年髋关节置换手术麻醉镇静用药的选择提供依据。方法选取2015年9月~2017年12月在陕西省汉中市中心医院行髋关节置换术的老年患者200例,按随机数字表法分为实验组与对照组,每组各100例。实验组患者给予静脉滴注右美托咪定1μg/kg,10min后以0.2μg/(kg·h)+丙泊酚维持;对照组给予静脉滴注0.9%氯化钠溶液+丙泊酚。比较两组患者麻醉前(T0)、切皮时(T1)、手术结束即刻(T2)、术后6h(T3)患者的心率(HR)、平均动脉压(MAP),及血清中的肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)、肌酐(Cr)和血尿素氮(BUN)水平变化。记录并观察患者苏醒期的不良反应发生率及T0、T3时的Ramsay镇静评分。结果实验组在T1、T2和T3时间点MAP和HR水平以及炎性因子TNF-α、CRP及IL-6水平均显著低于对照组(P<0.05)。T1、T2、T3时间点实验组的Cr和BUN水平均低于对照组,差异有统计学意义(P<0.05)。实验组不良反应发生率低于对照组,而Ramsay评分则高于对照组,差异有统计学意义(P<0.05)。结论右美托咪定应用于老年髋关节置换术可以抑制炎性因子的表达,对肾脏具有一定的保护作用,可以作为老年人髋关节置换术的麻醉辅助用药。 Objective To observe the effects of Dexmedetomidine on inflammatory factors and renal function in elderly patients after hip replacement treatment,and to provide basis for selection of anesthetic sedative medication for elderly patients undergoing hip replacement surgery.Methods A total of 200 elderly patients accepted hip replacement in Hanzhong Central Hospital of Shaanxi Province from September 2015 to December 2017 were selected and divided into experimental group and control group according to the random number table method,with 100 cases in each group.The patients in the experimental group were given 1μg/kg intravenous infusion of Dexmedetomidine,after 10 min,the patients were maintained by 0.2μg/(kg·h)Dexmedetomidine+Propofol;the control group were given intravenous injection of 0.9%sodium chloride solution+Propofol.Before anesthesia(T0),skin incision(T1),surgical(T2),the end of the postoperative 6 h(T3),the heart rate(HR),mean arterial pressure(MAP),and the serum tumor necrosis factor alpha(TNF-α),interleukin 6(IL-6),c-reactive protein(CRP),creatinine(Cr)and blood urea nitrogen(BUN)level changes of the two groups were compared.The incidence of adverse reactions during the recovery period and the Ramsay sedation score at T0 and T3 were recorded and observed.Results The levels of MAP and HR as well as the levels inflammatory factors TNF-α,CRP and IL-6 at T1,T2 and T3 in the experimental group were significantly lower than those in the control group(P<0.05).At T1,T2 and T3 time points,the levels of Cr and BUN in the experimental group was lower than that in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the experimental group was lower than that in the control group,and Ramsay score was higher than that in the control group,with statistically significant differences(P<0.05).Conclusion The application of Dexmedetomidine in elderly hip replacement can inhibit the expression of inflammatory factors and protect the kidneys,which can be used
作者 李雪丹 黄柯冰 黄杰 陈志惠 LI Xuedan;HUANG Kebing;HUANG Jie;CHEN Zhihui(Department of Anesthesiology,Hanzhong Central Hospital,Shaanxi Province,Hanzhong 723000,China)
出处 《中国医药导报》 CAS 2019年第4期104-107,共4页 China Medical Herald
基金 陕西省科学技术研究发展计划项目(2016SF-092)。
关键词 右美托咪啶 髋关节 炎性因子 肾功能 老年人 镇静 Dexmedetomidine Hip replacement Inflammatory factors Renal function Elderly Sedation
作者简介 通讯作者:黄柯冰(1977.11-),男,副主任医师,主要从事骨科方向的研究。
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