Shen Yading, Wang Chenyu, Zhong Xiaoping, Wu Yandan, He Xiaoxia
Department of Anesthesiology, Yiwu Central Hospital, Yiwu, China.
Department of Anesthesiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China.
Front Surg. 2022 Jul 1;9:928922. doi: 10.3389/fsurg.2022.928922. eCollection 2022.
To observe the anesthetic effect of dexmedetomidine combined with spinal anesthesia in hip arthroplasty, and to analyze the effects of dexmedetomidine on postoperative stress response, incidence of delirium, immune function and inflammatory indicators.
A total of 42 patients who underwent hip replacement in our hospital from March 2020 to June 2021 were selected as the research subjects and randomly divided into the control group and the observation group, 21 cases in each group. The control group was given intraspinal anesthesia, and the observation group was given dexmedetomidine on this basis. The onset time and maintenance time of sensory and motor nerve block were recorded. Stress response indexes [cortisol (Cor), blood glucose (Glu), adrenaline (E), noadrenaline (NE)], T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+), inflammatory indexes [tumor necrosis factor - (TNF-α) and interleukin-6 (IL-6)] were detected before and after operation, and the incidence of postoperative delirium in both groups was recorded.
The onset time of sensory nerve block and motor block in the observation group were lower than those in the control group, and the retention time of sensory nerve block and motor nerve block were higher than those in the control group ( < 0.05). After surgery, the levels of Cor, Glu, E and NE in the observation group were lower than those in the control group ( < 0.05). After surgery, the incidence of postoperative delirium in the observation group (4.79%) was lower than that in the control group (28.57%) ( < 0.05). After surgery, the levels of CD3+, CD4+, CD8+, and CD4+/CD8+ in the observation group were higher than those in the control group ( < 0.05). After surgery, the levels of TNF-α and IL-6 in the observation group were lower than those in the control group ( < 0.05).
The combined use of dexmedetomidine and intraspinal anesthesia has good anesthesia effect in hip joint replacement, which can greatly reduce the stress response of patients, reduce the incidence of postoperative delirium, and effectively restore the immune function of patients, reduce the level of inflammatory response, and has high clinical application value.
观察右美托咪定联合腰麻在髋关节置换术中的麻醉效果，并分析右美托咪定对术后应激反应、谵妄发生率、免疫功能及炎症指标的影响。
选取2020年3月至2021年6月在我院行髋关节置换术的42例患者作为研究对象，随机分为对照组和观察组，每组21例。对照组给予腰麻，观察组在此基础上给予右美托咪定。记录感觉和运动神经阻滞的起效时间和维持时间。检测手术前后应激反应指标[皮质醇（Cor）、血糖（Glu）、肾上腺素（E）、去甲肾上腺素（NE）]、T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）、炎症指标[肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）]，并记录两组术后谵妄的发生率。
观察组感觉神经阻滞和运动阻滞的起效时间低于对照组，感觉神经阻滞和运动神经阻滞的维持时间高于对照组（<0.05）。术后，观察组Cor、Glu、E和NE水平低于对照组（<0.05）。术后，观察组术后谵妄发生率（4.79%）低于对照组（28.57%）（<0.05）。术后，观察组CD3+、CD4+、CD8+及CD4+/CD8+水平高于对照组（<0.05）。术后，观察组TNF-α和IL-6水平低于对照组（<0.05）。
右美托咪定联合腰麻在髋关节置换术中具有良好的麻醉效果，可大大降低患者的应激反应，降低术后谵妄的发生率，有效恢复患者的免疫功能，降低炎症反应水平，具有较高的临床应用价值。
