右美托咪定对椎管内麻醉手术患者应激反应血流动力及免疫功能的影响

doi:10.3969/j.issn.1006-6233.2021.01.005

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摘要 目的: 探讨右美托咪定用于椎管内麻醉手术对患者应激反应、血流动力及免疫功能的影响。方法: 回顾性选择2015年11月至2018年9月于我院进行椎管内麻醉手术治疗的患者192例为研究对象,根据随机数表法简单随机分成两组,各96例。对照组术中行丙泊酚治疗,研究组采用右美托咪定治疗,比较手术前后应激反应指标(NE、E、Cor),观察两组手术后血流动力学指标(MAP、HR、SpO₂)变化,比较两组患者手术前后T细胞亚群水平(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺),并观察两组不良反应发生情况。结果: 手术前,两组患者NE、E、Cor水平无明显差异(P>0.05),手术后,研究组NE、E、Cor水平均低于对照组(P<0.05)。研究组手术后MAP、HR水平低于对照组,SpO₂水平高于对照组(P<0.05)。术前两组患者CD3⁺、CD4⁺、CD8⁺和CD4⁺/CD8⁺无明显差异(P>0.05),手术后,研究组CD3⁺、CD4⁺、CD8⁺和CD4⁺/CD8⁺均明显高于对照组(P<0.05)。研究组不良反应发生率为7.29%,对照组为21.88%,组间比较差异有统计学意义(χ²=12.335,P=0.002)。结论: 右美托咪定应用于椎管内麻醉手术中,可有效降低患者应激反应,且对患者免疫功能的改善及不良反应的降低具有重要作用。

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	代晨旭
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关键词 ：右美托咪定, 丙泊酚, 椎管内麻醉, 应激反应

Abstract：Objective: To ivestigate the effect of dexmedetomidine on stress response in patients undergoing spinal anaesthesia. Methods: A total of 192 patients who underwent spinal anesthesia in our hospital from November 2015 to September 2018 were selected retrospectively as the study subjects. According to the random number table method, they were simply randomly divided into two groups, 96 patients in each group. Control group was treated with propofol, and research group was treated with dexmedetomidine. Stress response indexes (NE, E, Cor) were compared before and after surgery. The two groups were observed of postoperative hemodynamic indexes (MAP, HR, SpO₂) change. The levels of T cell subsets (CD3⁺, CD4⁺, CD8⁺, CD4⁺ / CD8⁺) was compared, and adverse reactions occurred in both groups were recorded. Results: Before surgery, there was no significant difference in NE, E, Cor levels between the two groups (P>0.05). After operation, the levels of NE, E and Cor in the study group were lower than those in the control group (P<0.05).MAP and HR levels in the study group were lower than those in the control group, and SpO₂ levels were higher than those in the control group (P<0.05).There was no significant difference in CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺(P>0.05). After operation, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were significantly higher in the study group than in the control group(P<0.05).The incidence of adverse reactions was 7.29% in the study group and 21.88% in the control group, with statistically significant differences (χ²=12.335, P=0.002). Conclusion: Dexmedetomidine, applied in spinal anesthesia, can effectively reduce the stress response of patients, and plays an important role in improving the immune function and reducing the adverse reactions of patients.

Key words： Dexmedetomidine Propofol Intraspinal anesthesia Stress response

基金资助:安徽省科技厅科技计划项目,(编号:1501ld04055)

引用本文:

代晨旭, 蔡宁, 官双双. 右美托咪定对椎管内麻醉手术患者应激反应血流动力及免疫功能的影响[J]. 河北医学, 2021, 27(1): 18-22.
DAI Chenxu, CAI Ning, GUAN Shuangshuang. Effect of Dexmedetomidine on Stress Response Hemodynamics and Immune Function in Patients Undergoing Spinal Anesthesia. HeBei Med, 2021, 27(1): 18-22.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.01.005 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I1/18