[1]于 健,单士强,聂 宇,等.局部使用右美托咪定对老年患者髋部手术术后认知功能Toll样受体4表达的影响[J].医学信息,2018,31(21):75-78.[doi:10.3969/j.issn.1006-1959.2018.21.020]
　YU Jian,SHAN Shi-qiang,NIE Yu,et al.Effects of Local Use of Dexmetomidine on Cognitive Function and Expression of Toll Like Receptor 4 after Hip Surgery in Elderly Patients[J].Journal of Medical Information,2018,31(21):75-78.[doi:10.3969/j.issn.1006-1959.2018.21.020]
点击复制

局部使用右美托咪定对老年患者髋部手术术后认知功能Toll样受体4表达的影响()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
31卷
期数:
2018年21期
页码:
75-78
栏目:
论著
出版日期:
2018-11-01

文章信息/Info

Title:
Effects of Local Use of Dexmetomidine on Cognitive Function and Expression of Toll Like Receptor 4 after Hip Surgery in Elderly Patients
文章编号:
1006-1959（2018）21-0075-05
作者:
于 健; 单士强; 聂 宇; 王 雷
河北省沧州市中心医院麻醉一科，河北 沧州 061001
Author(s):
YU Jian; SHAN Shi-qiang; NIE Yu; WANG Lei
Department of Anesthesiology,Subject One,Central Hospital of Cangzhou,Cangzhou 061001， Hebei,China
关键词:
右美托咪定; 认知障碍; Toll样受体4; 炎性因子
Keywords:
Dexmedetomidine; Cognitive impairment; Toll-like receptor 4; Inflammatory factor
分类号:
R614.3
DOI:
10.3969/j.issn.1006-1959.2018.21.020
文献标志码:
A
摘要:
目的 探讨右美托咪定局部用药对老年患者髋部手术术后认知功能和单核细胞Toll样受体4表达的影响。方法 择期股骨上段骨折行动力髋螺钉植入系统内固定术60例，采用随机数字表法分为罗哌卡因组（R组）和右美托咪定混合罗哌卡因组（RD组），每组30例。所有患者均采用神经刺激仪引导腰丛+坐骨神经阻滞法麻醉，R组注射0.5%罗哌卡因，RD组注射含右美托咪定1.5 μg/kg的0.5%罗哌卡因，腰丛20 ml、坐骨神经10 ml。于术前1 d（T0）、术毕即刻（T1）、术后1 d（T2）、术后3 d（T3）取静脉血，观察单核细胞TLR4的表达，并于T0、T1、T2、T3、术后7 d（T4）测定白细胞介素-1β、肿瘤坏死因子-α水平。于T0、T2、T3、T4应用MoCA评估认知功能，记录术后认知功能障碍的发生情况。结果 与T0比较，两组患者T2~T3时MoCA评分降低，T1~T3时血浆TNF-α、IL-1β水平升高（P＜0.05）；与R组比较，RD组T2~T3时MoCA评分均高于R组， T1~T2时TLR4表达下调，T1~T3时TNF-α、IL-1β水平降低（P＜0.05）。RD组术后认知功能障碍发生率低于R组（P＜0.05）。结论 右美托咪定局部用药可能预防老年患者术后认知功能障碍的发生，机制可能与抑制TLR4蛋白的表达，减少炎性因子释放有关。
Abstract:
Objective To investigate the effects of dexmetomidine on cognitive function and monocyte Toll like receptor 4 expression in elderly patients after hip surgery.Methods 60 patients with elective upper femoral fractures were treated with hip screw fixation system. They were randomly divided into ropivacaine group (R group) and dexmedetomidine mixed ropivacaine group (RD group). 30 cases in each group. All patients underwent a lumbar plexus + sciatic nerve block anesthesia with a neurostimulator, 0.5% ropivacaine in the R group, and 0.5% ropivacaine containing dexmedetomidine 1.5 μg/kg in the RD group.20 ml of lumbar plexus and 10 ml of sciatic nerve. Venous blood was taken 1 d(T0),venous blood was taken immediately after surgery(T1), 1 day after surgery (T2), and 3 days after surgery(T3). The expression of TLR4 in monocytes was observed at T0, T1, T2, T3, and 7 days after surgery (T4). The levels of interleukin-1β and tumor necrosis factor-α were measured. MoCA was used to evaluate cognitive function at T0, T2, T3, and T4, and the incidence of postoperative cognitive dysfunction was recorded.Results Compared with T0, the MoCA scores decreased in T2~T3, and the levels of plasma TNF-α and IL-1β in T1~T3 increased(P<0.05).Compared with R group, the MoCA scores of T2~T3 in RD group were higher than those in R group. The expression of TLR4 was down-regulated at T1~T2, and the levels of TNF-α and IL-1β were decreased at T1~T3 (P<0.05). The incidence of postoperative cognitive dysfunction in the RD group was lower than that in the R group(P<0.05). Conclusion The local administration of Dexmetomidine may prevent the occurrence of cognitive dysfunction in elderly patients after operation, and the mechanism may be related to the inhibition of TLR4 protein expression and the reduction of inflammatory factor release.

参考文献/References:

[1]Gao R,Kan MQ,Wang SG,et al.Disrupted tryptophan metabolism induced cognitive impairment in a mouse model of sepsis-associated encephalopathy[J].Inflammation,2016,39(2):550-560． [2]鲁稳梁,杨现会,董铁立.手术创伤因素对老龄小鼠海马TLR4表达的影响[J].中华麻醉学杂志,2015,35 (12):1439-1442. [3]Huang XZ,Tu WF,Peng J,et al.Effect of preemptive local injection of ropivocaine with dexmedetomidine on mirror pain in rats and its mechanism[J].Asian Pac J Trop Med,2015,8(10): 836-840. [4]Prinz M,Garbe F,Schmidt H,et al.Innate immunity mediated by TLR9 modulates pathogenicity in an animal model of multiple sclerosis[J].J Clin Invest,2006,116(2):456-464． [5]Song Y,Qu R,Zhu S,et al.Rhynchophylline Attenuates LPS-induced Pro-inflammatory Responses through Down-regulation of MAPK/NF-κB Signaling Pathways in Primary Microglia[J].Phytother Res，2012,26(10):1528-1533. [6]Abildstrom H,Rasmussen LS,Rentowl P,et al.Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly.ISPOCDgroup.International study of postoperative cognitive dysfunction[J].Acta Anaesthesiol Scand,2000,44(10):1246-1251. [7]徐宏伟,张兰,苏丽,等.腰丛-坐骨神经联合阻滞在高龄老年患者股骨上段骨折手术中的应用[J].临床麻醉学杂志,2008,24(5):403-405. [8]Abdallah FW,Dwyer T,Chan VW,et al.Ⅳ and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block:a randomized,three-arm, triple-masked,placebo-controlled trial[J].Anesthesiology,2015,124(3):683-695. [9]Yang YC,Meng QT,Pan X,et al.Dexmedetomidine produced analgesic effect via inhibition of HCN currents[J].Eur J Pharmacol,2014(740):560-564. [10]于健,李睿,郭庆夺,等.混合罗哌卡因用于腰丛-坐骨神经阻滞时右美托咪定的适宜剂量[J].中华麻醉学杂志,2014,34(11):1369-1371. [11]李井柱,李小征,王晓敏,等.MoCA法评估脊柱手术老年患者术后认知功能障碍的可靠性:与MMSE法比较[J].中华麻醉学杂志,2014(34):129-131． [12]崔敏,司纪国,盖长新.不同剂量右美托咪定对妇科腹腔镜手术患者围术期炎症因子和术后认知功能的影响[J].中国当代医药,2015,22(30):53-55. [13]Abraham J,Johnson RW.Central inhibition of interleukin-1 beta ameliorates sickness behavior in aged mice[J].Brain Behav Immun,2009,23(3):396-341． [14]Wang Y,He H,Li D,et al.The role of the TLR4 signaling pathway in cognitive deficits following surgery in aged rats[J].Mol Med Rep,2013,7(4):1137-1142．

相似文献/References:

[1]杨进斌,韩建阁.右美托咪定复合丙泊酚和芬太尼在无痛人流术中的应用观察[J].医学信息,2018,31(03):134.[doi:10.3969/j.issn.1006-1959.2018.03.047]
　YANG Jin-bin,HAN Jian-ge.Application of Dexmetomidine Combined with Propofol and Fentanyl in Painless Induced Abortion[J].Journal of Medical Information,2018,31(21):134.[doi:10.3969/j.issn.1006-1959.2018.03.047]
[2]侯 江.舒芬太尼联合右美托咪定用于临床麻醉的效果观察[J].医学信息,2018,31(03):144.[doi:10.3969/j.issn.1006-1959.2018.03.051]
　HOU Jiang.Clinical Observation on the Effect of Sufendate Combined with Dexlansoprazole in Clinical Anesthesia[J].Journal of Medical Information,2018,31(21):144.[doi:10.3969/j.issn.1006-1959.2018.03.051]
[3]陶 晶,王 鑫,黄 擘,等.右美托咪定对截肢术后发生谵妄的疗效观察[J].医学信息,2018,31(04):123.[doi:10.3969/j.issn.1006-1959.2018.04.043]
　TAO Jing,WANG Xin,HUANG Bo,et al.Therapeutic Effect of Dexmedetomidine on Delirium after Amputation[J].Journal of Medical Information,2018,31(21):123.[doi:10.3969/j.issn.1006-1959.2018.04.043]
[4]江亚楠,梁永新,施彩凤,等.右美托咪定在大鼠脊髓缺血再灌注损伤中的 保护作用及机制研究[J].医学信息,2018,31(07):69.[doi:10.3969/j.issn.1006-1959.2018.07.022]
　JIANG Ya-nan,LIANG Yong-xin,SHI Cai-feng,et al.Protective Effects and Mechanism of Dexmedetomidine on Spinal Cord Ischemia-Reperfusion Injury in Rats[J].Journal of Medical Information,2018,31(21):69.[doi:10.3969/j.issn.1006-1959.2018.07.022]
[5]孙素花,宋建防,褚海辰,等.右美托咪定经鼻给药在胸腔镜肺叶切除术中的疗效观察[J].医学信息,2018,31(07):78.[doi:10.3969/j.issn.1006-1959.2018.07.025]
　SUN Su-hua,SONG Jian-fang,CHU Hai-chen,et al.Efficacy of Dexmetomidine in Thoracoscopic Lobectomy by Nasal Administration[J].Journal of Medical Information,2018,31(21):78.[doi:10.3969/j.issn.1006-1959.2018.07.025]
[6]王绪飞,梁永新.右美托咪定复合布比卡因骶管阻滞对预防七氟醚 小儿麻醉苏醒期躁动的观察分析[J].医学信息,2018,31(08):78.[doi:10.3969/j.issn.1006-1959.2018.08.024]
　WANG Xu-fei,LIANG Yong-xin.Observation of Dexmedetomidine Combined with Bupivacaine Caudal Block in Preventing Sedation in Children with Sevoflurane during Anesthesia Recovery Period[J].Journal of Medical Information,2018,31(21):78.[doi:10.3969/j.issn.1006-1959.2018.08.024]
[7]李 璟,蒋 娜,王晶晶,等.右美托咪定对H9C2心肌细胞缺氧/复氧损伤的保护作用[J].医学信息,2018,31(09):83.[doi:10.3969/j.issn.1006-1959.2018.09.025]
　LI Jing,JIANG Na,WANG Jing-jing,et al.Protective Effects of Dexmedetomidine on Hypoxia/Reoxygenation Injury in H9C2 Cardiomyocytes[J].Journal of Medical Information,2018,31(21):83.[doi:10.3969/j.issn.1006-1959.2018.09.025]
[8]赵 亮,王绍林.右美托咪定滴鼻和七氟烷吸入对患儿麻醉前镇静和 苏醒后躁动的影响[J].医学信息,2018,31(10):124.[doi:10.3969/j.issn.1006-1959.2018.10.040]
　ZHAO Liang,WANG Shao-lin.Effects of Dexmedetomidine Dripping and Seven Halothane Inhalation on Sedation and Recovery Agitation after Anesthesia in Children[J].Journal of Medical Information,2018,31(21):124.[doi:10.3969/j.issn.1006-1959.2018.10.040]
[9]疏 腾,胡胜红,叶 慧,等.静脉输注右美托咪定对甲状腺切除手术患者术后恢复质量的影响[J].医学信息,2022,35(09):161.[doi:10.3969/j.issn.1006-1959.2022.09.041]
　SHU Teng,HU Sheng-hong,YE Hui,et al.Effect of Intravenous Infusion of Dexmedetomidine on Postoperative Recovery Quality in Patients Undergoing Thyroid Surgery[J].Journal of Medical Information,2022,35(21):161.[doi:10.3969/j.issn.1006-1959.2022.09.041]
[10]程 燕,张 宁,郭金光.右美托咪定替代瑞芬太尼对甲状腺手术 全麻患者术后恶心呕吐的影响[J].医学信息,2018,31(12):83.[doi:10.3969/j.issn.1006-1959.2018.12.025]
　CHENG Yan,ZHANGN Ning,GUO Jin-guang.Effect of Dexmedetomidine in Place of Remifentanil on Postoperative Nausea and Vomiting in General Anesthesia Patients Undergoing Thyroid Surgery[J].Journal of Medical Information,2018,31(21):83.[doi:10.3969/j.issn.1006-1959.2018.12.025]

更新日期/Last Update: 2018-11-20