应用右美托咪定对下肢骨折患儿术后应激反应及脑组织氧代谢的影响

doi:10.3969/j.issn.1671-7171.2026.03.023

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1215 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 【目的】探讨应用右美托咪定(Dex)对下肢骨折患儿术后应激反应及脑组织氧代谢的影响。【方法】86例行下肢骨折手术的患儿,随机分为观察组和对照组,每组43例。观察组于麻醉诱导前给予Dex,对照组给予等量生理盐水静脉注射。比较两组患者手术情况,手术前后应激反应指标、神经功能指标、脑组织氧代谢指标及不良反应发生情况。【结果】 观察组自主呼吸恢复时间、意识苏醒时间及拔管时间均短于对照组(P<0.05),术后1 h 视觉模拟评分法(VAS)评分低于对照组, Ramsay镇静评分高于对照组(P<0.05)。术后,两组丙二醛(MDA)水平高于术前(P<0.05),但观察组低于对照组(P<0.05);两组超氧化物歧化酶(SOD)、血红素氧合酶1(HO-1)水平低于术前,但观察组高于对照组(P<0.05);两组胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、S100β蛋白水平均高于术前(P<0.05),但观察组低于对照组(P<0.05);两组颈内脑氧摄取率(CERO₂)、静脉血氧含量(CjvO₂)、动脉血氧含量(CaO₂)水平均低于术前(P<0.05),且观察组CaO₂、CjvO₂水平高于对照组,CERO₂水平低于对照组(P<0.05)。两组各项不良反应发生率比较,差异均无统计学意义(P>0.05)。【结论】 下肢骨折手术中应用Dex具有较好的麻醉效果,对患儿术后应激反应及神经功能影响较小,且能够改善患儿术后脑组织氧代谢,同时安全性好。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	单成静
	彭蓓
	吴小乐
	杨晨

关键词 ：下肢骨, 骨折, 右美托咪定, 应激, 生理学, 儿童

Abstract：【Objective】 To investigate the effects of dexmedetomidine (Dex) on postoperative stress response and cerebral oxygen metabolism in children undergoing surgery for lower limb fractures. 【Methods】 A total of 86 children scheduled for lower limb fracture surgery were randomly assigned to an observation group or a control group, with 43 cases in each group. The observation group received Dex before anesthesia induction, while the control group was intravenously injected with an equal volume of normal saline. Surgical conditions, stress response indices, neurological function indices, cerebral oxygen metabolism parameters, and the incidence of adverse reactions before and after surgery were compared between the two groups. 【Results】 The times to recovery of spontaneous respiration, recovery of consciousness, and extubation were significantly shorter in the observation group than in the control group (P<0.05). At 1 h postoperatively, the visual analogue scale (VAS) score was lower and the Ramsay score was higher in the observation group than in the control group (P<0.05). Postoperatively, malondialdehyde (MDA) levels increased in both groups compared with preoperative levels (P<0.05), but the MDA level in the observation group was lower than that in the control group (P<0.05). Superoxide dismutase (SOD) and heme oxygenase-1 (HO-1) levels decreased in both groups after surgery, but they both were higher in the observation group than in the control group (P<0.05). Levels of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and S100β protein were higher postoperatively in both groups (P<0.05), but they were lower in the observation group than in the control group (P<0.05). The cerebral oxygen extraction ratio (CERO₂), jugular venous oxygen content (CjvO₂), and arterial oxygen content (CaO₂) decreased postoperatively in both groups (P<0.05). Compared with the control group, the observation group showed higher CaO₂ and CjvO₂ levels but a lower CERO₂ level (P<0.05). There were no significant differences in the incidence of adverse reactions between the two groups (P>0.05). 【Conclusion】 The intraoperative application of Dex in children undergoing lower limb fracture surgery provides favorable anesthetic effects, has minimal impact on postoperative stress response and neurological function, improves postoperative cerebral oxygen metabolism, and demonstrates good safety.

Key words： Bones of Lower Extremity Fractures Dexmedetomidine Stress, Physiological Child

收稿日期: 2024-12-15

中图分类号:

R726.83

通讯作者: * E-mail:yangchenmzk@163.com

引用本文:

单成静, 彭蓓, 吴小乐, 杨晨. 应用右美托咪定对下肢骨折患儿术后应激反应及脑组织氧代谢的影响[J]. 医学临床研究, 2026, 43(3): 435-438.
SHAN Chengjing, PENG Bei, WU Xiaole, YANG Chen. Effects of Dexmedetomidine on Postoperative Stress Response and Cerebral Oxygen Metabolism in Children with Lower Limb Fractures. JOURNAL OF CLINICAL RESEARCH, 2026, 43(3): 435-438.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.03.023 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I3/435

[1] YIN B, HE Y M, WANG D, et al. Classification of femur trochanteric fracture: Evaluating the reliability of Tang classification[J].Injury,2021,52(6):1500-1505.
[2] 吴蔚华,吴国保,金名花.右美托咪定与瑞芬太尼对老年髋部骨折手术患者血流动力学及认知功能障碍的影响[J].中国老年学杂志,2021,41(8):1657-1660.
[3] SHOLJAKOVA M, TRAJKOVA R, DURNEV V, et al. Post -anesthesia cognitive dysfunction of aged patients in one day surgery[J].Int J Sci Res (IJSR),2020, 9(1):152-156.
[4] CHITNIS S, MULLANE D, BROHAN J, et al. Dexmedetomidine use in intensive care unit sedation and postoperative recovery in elderly patients post-cardiac surgery (DIRECT)[J].J Cardiothorac Vasc Anesth,2022,36(3):880-892.
[5] IRLBECK T, ZWIBLER B, BAUER A. ASA classification : Transition in the course of time and depiction in the literature[J].Anaesthesist,2017,66(1):5-10.
[6] MASON K P, MICHNA E, ZURAKOWSKI D, et al. Value of bispectral index monitor in differentiating between moderate and deep Ramsay Sedation Scores in children[J].Paediatr Anaesth,2006,16(12):1226-1231.
[7] KANE R L, BERSHADSKY B, ROCKWOOD T, et al. Visual Analog Scale pain reporting was standardized[J].J Clin Epidemiol,2005,58(6):618-623.
[8] 刘巍,陈小龙,张浩泉.患肢皮牵引辅助手法整复夹板外固定治疗小儿股骨干骨折[J].临床骨科杂志,2023,26(2):270-275.
[9] 李远劲,杨琦.股骨骨折患者给予闭合复位髓内钉治疗的临床效果研究[J].重庆医学,2022,51(2):278-280.
[10] 王金林,王领,杨银旗,等.金莲花软胶囊联合右美托咪定用于儿童扁桃体腺样体切除术后镇痛效果及对炎性因子、血流动力学的影响[J].中华中医药学刊,2022,40(8):205-208.
[11] 葛建岭,王伟,杨勇,等.右美托咪定、舒芬太尼联合小剂量丙泊酚用于宫腔镜手术麻醉的临床效果[J].山东医药,2023,63(7):65-67.
[12] 何心海,陈星同,杨子恒,等.右美托咪定调节巨噬细胞极化抑制肾缺血再灌注系统炎性反应[J].第三军医大学学报,2020,42(6):611-615.
[13] 吴迪,李俊青,袁浩,等.右美托咪定对老年肺部手术患者术后谵妄发生率、脑氧代谢的影响[J].中国现代医学杂志,2022,32(14):71-76.
[14] 王园,李勇,崔爱武,等.低剂量右美托咪定联合舒芬太尼对老年髋部骨折手术患者术后疼痛应激及认知损伤的影响[J].中国老年学杂志,2021,41(4):790-793.