摘要
目的观察右美托咪定对下肢踝关节手术使用止血带引起下肢缺血再灌注损伤的保护作用。方法选择2019年1月至2020年12月在该院行下肢踝关节手术患者90例,并将其分为观察组和对照组,各45例。两组患者均采用蛛网膜下腔阻滞麻醉,对照组术中常规使用止血带,观察组在使用止血带前予以右美托咪定。观察两组患者使用止血带前(T_(0))及松止血带后15 min(T_(1))、30 min(T_(2))、60 min(T_(3))、2 h(T_(4))的心率(HR)、平均动脉压(MAP)、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-10、8-异前列腺素F2α(8-iso-PGF2α)、一氧化氮(NO)、乳酸脱氢酶(LDH)、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平的变化,以及两组患者不良反应发生情况。结果两组T 0~T_(4)各时点HR、MAP、PaCO_(2)和PaO_(2)水平差异无统计学意义(P>0.05)。两组T 0时点血清TNF-α、IL-10、8-iso-PGF2α、NO、LDH、CK和CK-MB水平差异无统计学意义(P>0.05);两组T_(1)~T_(4)时点血清TNF-α、8-iso-PGF2α、NO、LDH、CK和CK-MB水平较T 0时点明显升高,血清IL-10水平较T 0时点明显降低,且对照组升高或降低水平较观察组更明显,差异均有统计学意义(P<0.05)。观察组低血压和心动过缓发生率明显高于对照组,而高血压和止血带疼痛发生率明显低于对照组,差异有统计学意义(P<0.05);两组呕吐发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定可通过降低机体炎症因子水平,缓解下肢肌肉损伤,从而达到对使用止血带引起的下肢缺血再灌注损伤的保护作用。
Objective To observe the protective effect of dexmedetomidine on ischemia-reperfusion injury caused by the tourniquet in lower extremity ankle surgery.Methods A total of 90 patients who underwent lower extremity ankle surgery in our hospital from January 2019 to December 2020 were selected and divided into observation group and control group,with 45 cases in each group.Patients in both groups were given subarach noid block anesthesia,the control group was routinely treated with tourniquet during operation,and the observation group was treated with dexmedetomidine before tourniquet.The heart rate(HR),mean arterial pressure(MAP),partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),tumor necrosis factor(TNF)-α,interleukin(IL)-10,8-isoprostaglandin F2α(8-iso-PGF2α),nitric oxide(NO),lactate dehydrogenase(LDH),creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)before tourniquet application(T_(0)),15 min(T_(1)),30 min(T_(2)),60 min(T_(3))and 2 h(T_(4))after tourniquet release were observed in two groups respectively,and the rates of adverse reactions were compared in the two groups.Results There were no significant differences in HR,MAP,PaCO_(2) and PaO_(2) levels at T_(0)-T_(4) time points between the two groups(P>0.05).There were no significant differences in serum TNF-α,IL-10,8-iso-PGF2α,NO,LDH,CK and CK-MB levels between the two groups at T 0 time(P>0.05).The serum levels of TNF-α,8-iso-PGF2α,NO,LDH,CK and CK-MB in both groups at T_(1)-T_(4) time point were significantly higher than those at T 0 time point,and the serum IL-10 level was significantly lower than that at T 0 time point.The increase or decrease of the level in the control group was more obvious than that in the observation group,with statistical significance(P<0.05).The incidence of hypotension and bradycardia in the observation group was significantly higher than that in the control group,while the incidence of hypertension and tourniquet pain in the observation group was significantly lower than that in the control group(P<0.05).There was no statistical difference in the incidence of vomiting between the two groups(P>0.05).Conclusion Dexmedetomidine can protect the ischemia-reperfusion injury caused by tourniquet by reducing the level of inflammation and reducing the damage of lower extremity muscles.
作者
唐恩辉
徐华琴
蔡明珍
翁浩
TANG Enhui;XU Huaqin;CAI Mingzhen;WENG Hao(Department of Anesthesiology,Central Hospital of Fengxian District,Shanghai 201499,China)
出处
《检验医学与临床》
CAS
2021年第20期3002-3005,3009,共5页
Laboratory Medicine and Clinic
关键词
右美托咪定
下肢手术
止血带
缺血再灌注损伤
炎性反应
dexmedetomidine
lower limb surgery
tourniquet
ischemia-reperfusion injury
inflammatory response
作者简介
唐恩辉,男,主治医师,主要从事骨科手术麻醉相关研究;通信作者:翁浩,E-mail:wengwell@163.com。
