摘要
目的探讨右美托咪定对老年患者下肢手术中止血带所致氧化应激及炎症反应的影响。方法将168例行下肢手术平均年龄（67.6±6.4）岁（60~84岁）的老年患者,分为右美托咪定组（n=62）、丙泊酚组（n=52）和对照组（n=54）,均采用蛛网膜下腔阻滞麻醉联合硬膜外麻醉。完成穿刺后,右美托咪定组患者10min内给予负荷量1μg/kg右美托咪定静脉输注,后采用0.5μg/（kg·h）维持至术毕;丙泊酚组患者给予丙泊酚靶控静脉输注,起始靶浓度1.0μg/mL,与效应室浓度平衡3min后,以0.2μg/mL递增;对照组患者给予与右美托咪定组同剂量、同速率生理盐水输注。分别于使用止血带前（T0）,松开止血带后10min（T1）,30min（T2）和60min（T3）时,采用ELISA法检测血清超氧化物歧化酶（SOD）、丙二醛（MDA）、C-反应蛋白（CRP）、白细胞介素-8（IL-8）和人肿瘤坏死因子-α（TNF-α）。结果 T1~T3时点,右美托咪定组和丙泊酚组患者血清SOD含量均高于对照组,MDA和CRP含量均低于对照组（均P〈0.05）;T2、T3时点,右美托咪定组患者SOD含量高于丙泊酚组,MDA和CRP含量低于丙泊酚组（均P〈0.05）;T1~T3时点,右美托咪定组和丙泊酚组患者血清IL-8和TNF-α含量均低于对照组（均P〈0.05）,右美托咪定组患者血清IL-8和TNF-α含量均低于丙泊酚组（均P〈0.05）。结论右美托咪定应用于下肢手术老年患者,可有效减少由于使用止血带所导致的氧化应激及炎症反应。
Objective To investigate the impact of dexmedetomidine on the tourniquet-induced oxidative stress and inflammatory responses in elderly undergoing lower limb surgery.Methods A total of 168 elderly patients [average age：（67.6±6.4）years,range：60-84years]undergoing elective lower limb surgery were divided into dexmedetomidine group（n=62）,propofol group（n=52）and control group（n=54）.They were given spinal anesthesia combined with epidural anesthesia.After completion of the puncture,patients in the dexmedetomidine group were intravenously injected with dexmedetomidine at a dose of 1μg/kg within 10 min,and then 0.5μg/（kg·h）dexmedetomidine was used to maintain the anesthesia until the end of surgery.In the propofol group,patients were given propofol target-controlled infusion at the initial concentration of 1.0μg/mL,which was increased at a rate of 0.2μg/mL after balancing with effect-site concentration for 3min.Patients in the control group received the same dose and the same rate of saline infusion.The superoxide dismutase（SOD）,malondialdehyde（MDA）,C-reactive protein（CRP）,interleukin-8（IL-8）and human tumor necrosis factor-α（TNF-α）in serum were detected by ELISA before use of the tourniquet（T0）,10（T1）,30（T2）,and 60（T3）min after release of the tourniquet.Results At T1-T3,the concentrations of SOD were much higher,while the concentrations of MDA and CRP were much lower in the dexmedetomidine group and propofol group than in the control group（P〈0.05）.At T2 and T3,the concentrations of SOD were significantly higher,while the concentrations of MDA and CRP were significantly lower in the dexmedetomidine group than in the propofol group（P〈0.05）.At T1-T3,the concentrations of IL-8and TNF-α were profoundly decreased in the dexmedetomidine group and propofol group when compared with the control group（P〈0.05）,and they were much lower in the dexmedetomidine group than in the propofol group（P〈0.05）.Conclusion Dexmedetomidine can effectively reduce the tourniquet-induced oxidative stress and inflammatory responses in elderly patient undergoing lower limb surgery.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2015年第3期310-313,343,共5页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词
右美托咪定
氧化应激
炎症反应
老年
止血带
dexmedetomidine
oxidative stress
inflammatory response
elderly
tourniquet
作者简介
张继晨，女，1974年生，主治医师，E-mail：402767260@qq．com
