[1]杨　燕,张运琼,黄　沾,等.右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响[J].新乡医学院学报,2020,37(3):277-281.[doi:10.7683/xxyxyxb.2020.03.019]
　YANG Yan,ZHANG Yunqiong,HUANG Zhan,et al.Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery[J].Journal of Xinxiang Medical University,2020,37(3):277-281.[doi:10.7683/xxyxyxb.2020.03.019]
点击复制

右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年3
页码:
277-281
栏目:
临床研究
出版日期:
2020-03-12

文章信息/Info

Title:
Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery
作者:
杨　燕; 张运琼; 黄　沾; 王中胜; 银西洋; 刘志莲
（泸州市中医医院麻醉科，四川　泸州　646000）
Author(s):
YANG Yan; ZHANG Yunqiong; HUANG Zhan; WANG ZhongSheng; YIN Xiyang; Liu Zhilian
(Department of Anesthesia,Luzhou Traditional Chinese Medicine Hospital,Luzhou 646000,Sichuan Province,China)
关键词:
右美托咪定; 脊柱; 应激反应; 炎症反应; 免疫功能
Keywords:
dexmedetomidine; spine; stress response; inflammatory reaction; immunity
分类号:
R614
DOI:
10.7683/xxyxyxb.2020.03.019
文献标志码:
A
摘要:
目的　探讨右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应及免疫功能的影响。方法　选择2018年1月至2019年1月于泸州市中医医院进行脊柱手术治疗的98例患者为研究对象，将患者随机分为观察组和对照组，每组49例。对照组患者给予舒芬太尼术后镇痛，观察组患者给予舒芬太尼联合右美托咪定术后镇痛。比较2组患者术毕即刻及术后4、24 h血清促肾上腺皮质激素（ACTH）、皮质醇（Cor）、醛固酮（ALD）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、丙二醛（MDA）、超氧化物歧化酶（SOD）、羟自由基（·OH）和T细胞亚群水平。结果　2组患者术毕即刻血清ACTH、Cor、ALD、CRP、TNF-α、MDA、SOD、·OH、CD3+、CD4+、CD8+水平及CD4+/ CD8+比值比较差异均无统计学意义（P>0.05）。2组患者术后4、24 h血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于术毕即刻，SOD水平高于术毕即刻（P<0.05）；2组患者术后24 h血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于术后4 h，SOD水平高于术后4 h（P<0.05）。术后4、24 h，观察组患者血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于对照组，SOD水平高于对照组（P<0.05）。 观察组患者术后4、24 h CD3+、CD4+水平及CD4+/ CD8+比值均高于术毕即刻（P<0.05），观察组患者术后24 h CD3+、CD4+水平及CD4+/ CD8+比值高于术后4 h（P<0.05），观察组患者术后各时间点CD8+水平比较差异均无统计学意义（P>0.05）。对照组患者术后各时间点CD3+、CD4+、CD8+水平及CD4+/ CD8+比值比较差异均无统计学意义（P>0.05）。术后4、24 h，观察组患者CD3+、CD4+水平及CD4+/ CD8+比值高于对照组（P<0.05），2组患者CD8+水平比较差异无统计学意义（P>0.05）。结论　应用右美托咪定联合舒芬太尼术后镇痛能够有效减轻脊柱手术患者的应激反应与炎症反应，保护患者的免疫功能。
Abstract:
Objective　To investigate the effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery.Methods　Ninety eight patients who underwent spinal surgery in Luzhou Traditional Chinese Medicine Hospital from January 2018 to January 2019 were selected and randomly divided into observation group (n=49) and control group (n=49).The patients in the control group were given sufentanil for postoperative analgesia,the patients in the observation group were given sufentanil combined with dexmedetomidine for postoperative analgesia.The levels of serum adrenocorticotropic hormone (ACTH),cortisol (Cor),aldosterone (ALD),C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),malondialdehyde (MDA),superoxide dismutase (SOD),hydroxyl radical (·OH)and T cell subsets were compared between the two groups at immediately after operation and 4,24 hours after operation.Results　There was no significant difference in the levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA,SOD,·OH ，CD3+，CD4+，CD8+ and the ratio of CD4+/ CD8+ between the two groups at immediately after operation (P>0.05).The levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA,·OH at 4,24 hours after operation were lower than those at immediately after operation in the two groups (P<0.05),and the level of SOD was higher than that at immediately after operation (P<0.05)；The levels of serum ACTH,Cor,ALD,CRP,TNF - α,MDA,·OH at 24 hours after operation were lower than those at 4 hours after operation in the two groups (P<0.05),and the level of SOD was higher than that at 4 hours after operation (P< 0.05).At 4,24 hours after operation,the levels of serum ACTH,Cor,ALD,CRP,TNF- α,MDA and ·OH of patients in the observation group were lower than those in the control group (P<0.05),and the level of SOD in the observation group was higher than that in the control group (P<0.05).The levels of CD3+,CD4+ and the ratio of CD4+/ CD8+ at 4，24 hours after operation were higher than those immediately after operation in the observation group (P<0.05)；the levels of CD3+,CD4+ and the ratio of CD4+/CD8+ at 24 hours after operation were significantly higher than those at 4 hours in the observation group (P<0.05);there was no significant difference in the level of CD8+ at each time point after operation in the observation group (P>0.05).There was no significant difference in the levels of CD3+,CD4+,CD8+ and the ratio of CD4+/ CD8+ at each time point after operation in the control group (P>0.05).At 4,24 hours after operation,the levels of CD3+,CD4+ and the ratio of CD4+/ CD8+ of patients in the observation group were higher than those in the control group (P<0.05)；there was no significant difference in the levels of CD8+ between the two groups (P>0.05).Conclusions　Dexmedetomidine combined with sufentanil for postoperative analgesia can effectively alleviate the stress response and inflammatory response of patients undergoing spinal surgery,and protect the immune function.

参考文献/References:

［1］　WAINWRIGHT T W,IMMINS T,MIDDLETON R G.Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery［J］.Best Pract Res Clin Anaesthesiol,2016,30(1):91-102.
［2］　BAJWA S J,HALDAR R.Pain management following spinal surgeries:an appraisal of the available options［J］.J Craniovertebr Junction Spine,2015,6(3):105-110.
［3］　金丹,白云,吴辉.右美托咪定辅助舒芬太尼镇痛对CPB下心脏瓣膜置换术后病人应激反应和炎性反应的影响［J］.中华麻醉学杂志,2016,36(1):49-52.
［4］　NAIK B I,NEMERGUT E C,KAZEMI A,et al.The effect of dexmedetomidine on postoperative opioid consumption and pain after major spine surgery［J］.Anesth Analg,2016,122(5):1646-1653.
［5］　郝小勇.右美托咪定联合舒芬太尼在脊柱手术患者 术后镇痛中的应用效果观察［J］.河南医学研究,2018,27(1):88-89.
［6］　KHETARPAL R,KATARIA A P,BAJAJ S,et al.Gabapentin vs pregabalin as a premedication in lower limb orthopaedics surgery under combined spinal epidural technique［J］.Anesth Essays Res,2016,10(2):262-267.
［7］　LINDLEY E M,MILLIGAN K,FARMER R,et al.Patient-controlled transdermal fentanyl versus intravenous morphine pump after spine surgery［J］.Orthopedics,2015,38(9):e819-e824.
［8］　高明涛,周南.右美托咪定复合舒芬太尼术后镇痛对子宫切除患者皮质醇水平和免疫功能的影响［J］.实用药物与临床,2016,19(2):190-192.
［9］　ZHANG X K,CHEN Q H,WANG W X,et al.Evaluation of dexmedetomidine in combination with sufentanil or butorphanol for postoperative analgesia in patients undergoing laparoscopic resection of gastrointestinal tumors:a quasi-experimental trial［J］.Medicine (Baltimore),2016,95(50):e5604.
［10］　PARK S J,SHIN S,KIM S H,et al.Comparison of dexmedetomidine and fentanyl as an adjuvant to ropivacaine for postoperative epidural analgesia in pediatric orthopedic surgery［J］.Yonsei Med J,2017,58(3):650-657.
［11］　COZZI G,LEGA S,GIORGI R,et al.Intranasal dexmedetomidine sedation as adjuvant therapy in acute asthma exacerbation with marked anxiety and agitation［J］.Ann Emerg Med,2017,69(1):125-127.
［12］　SOLIMAN R,ZOHRY G.The myocardial protective efect of dexmedeto-midine in high-risk patients undergoing aortic vascular surgery［J］.Ann Card Anaesth,2016,19(4):606-613.
［13］　GE D J,QI B,TANG G,et al.Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal colectomy:a consort-prospective,randomized,controlled clinical trial［J］.Medicine (Baltimore),2015,94(43):e1727.
［14］　PANCHGAR V,SHETTI A N,SUNITHA H B,et al.The effectiveness of intravenous dexmedetomidine on perioperative hemodynamics,analgesic requirement,and side effects profile in patients undergoing laparoscopic surgery under general anesthesia［J］.Anesth Essays Res,2017,11(1):72-77.
［15］　HAN C,GE S J,HUANG S Q,et al.Influence of different menstrual phases on the bispectral index during dexmedetomidine sedation［J］.Kaohsiung J Med Sci,2016,32(11):586-592.
［16］　王斌,赵星,孙艳玲.右美托咪定联合舒芬太尼对腹腔镜胃肠穿孔修补术后患者血流动力学、应激反应及炎性因子水平的影响［J］.海南医学院学报,2017,23(19):2664-2667.
［17］　SUTOVSKY J,BENCO M,SUTOVSKA M,et al.Cytokine and chemokine profile changes in patients with lower segment lumbar degenerative spondylolisthesis［J］.Int J Surg,2017,43:163-170.
［18］　陈波,彭文勇,屠文龙,等.右美托咪定对腹腔镜胃癌根治术患者氧化应激、糖代谢及术后镇痛的影响［J］.中华全科医学,2018,16(3):395-397.
［19］　权泽威,孔天宇,哈利,等.前列地尔对老年糖尿病肾病病人氧化应激、炎性因子及血管内皮因子的影响［J］.实用老年医学,2018,32(6):572-576.
［20］　SAMANTARAY A,HEMANTH N,GUNNAMPATI K,et al.Comparison of the effects of adding dexmedetomidine versus midazolam to intrathecal bupivacaine on postoperative analgesia［J］.Pain Physician,2015,18(1):71-77.

相似文献/References:

[1]孙凤霞,李玉侠,孙建明.增殖型脊柱结核20 例CT 分析[J].新乡医学院学报,2000,17(06):458.
[2]杨吉武,唐靖,朱新运,等.右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响[J].新乡医学院学报,2012,29(05):359.
[3]贾英萍,李郑琛,邱永升. 右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用[J].新乡医学院学报,2015,32(08):732.
[4]李克寒１,马　丽２,杨惠敏１,等. 右美托咪定对心脏瓣膜置换术患者的脑保护作用[J].新乡医学院学报,2015,32(08):762.
[5]吕绪磊,郝建华.剖宫产术中应用右美托咪定对子宫收缩剂不良反应的作用[J].新乡医学院学报,2015,32(11):1022.
[6]王　旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445.[doi:10.7683/xxyxyxb.2021.05.010]
　WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(3):445.[doi:10.7683/xxyxyxb.2021.05.010]
[7]周　军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353.[doi:10.7683/xxyxyxb.2019.04.013]
　ZHOU Jun,ZHANG Yuan-yuan,CONG Xu-hui,et al.Effect of dexmedetomidine on agitation during general anesthesia recovery period in children underwent tonsillectomy[J].Journal of Xinxiang Medical University,2019,36(3):353.[doi:10.7683/xxyxyxb.2019.04.013]
[8]张红伟,王卫卫,李晓芳,等.右美托咪定对咽喉部手术鼾症儿童术后躁动及血流动力学的影响[J].新乡医学院学报,2021,38(8):730.[doi:10.7683/xxyxyxb.2021.08.006]
　ZHANG Hongwei,WAGN Weiwei,LI Xiaofang,et al.Effect of dexmedetomidine on postoperative agitation and hemodynamics of patients with snoring after throat surgery[J].Journal of Xinxiang Medical University,2021,38(3):730.[doi:10.7683/xxyxyxb.2021.08.006]
[9]陈胜阳,张永强,刘　俊,等.右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响[J].新乡医学院学报,2021,38(9):828.[doi:10.7683/xxyxyxb.2021.09.006]
　CHEN Shengyang,ZHANG Yongqiang,LIU Jun,et al.Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting[J].Journal of Xinxiang Medical University,2021,38(3):828.[doi:10.7683/xxyxyxb.2021.09.006]
[10]周世凤,詹　玮,边成富.右美托咪定对行肝叶切除术原发性肝癌患者氧化应激、肝功能及外周血单核细胞内Toll样受体2和Toll样受体4表达的影响[J].新乡医学院学报,2020,37(9):869.[doi:10.7683/xxyxyxb.2020.09.015]
　ZHOU Shifeng,ZHAN Wei,BIAN Chengfu.Effect of dexmedetomidine on oxidative stress，liver function and expression of Toll-like receptor 2 and Toll-like receptor 4 in peripheral blood monouclear cells in patients with primary liver cancer undergoing hepalobectomy[J].Journal of Xinxiang Medical University,2020,37(3):869.[doi:10.7683/xxyxyxb.2020.09.015]

更新日期/Last Update: 2020-03-05