右美托咪定对止血带诱发下肢缺血再灌注损伤的影响

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摘要目的观察右美托咪定对止血带诱发下肢缺血再灌注期间体内炎性反应因子水平和氧化应激反应的影响。方法选择临床上应用止血带行关节镜下单侧前交叉韧带重建术的患者40例,随机分成对照组和右美托咪定组,每组各20例。右美托咪定组给予右美托咪定1 μg/kg的负荷量静脉泵注10 min,随后以1 μg/(kg·h)的速率持续泵入至手术结束。对照组以同样速率泵入0.9%生理盐水。各组于硬膜外麻醉前(T0),止血带充气1 h(T1),止血带释放后20 min(T2)、1 h(T3)、6 h(T4),分别抽取患侧股静脉血3 ml,检测各个时间点血清中超氧化物歧化酶(SOD)的活性、丙二醛(MDA)的浓度、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的浓度。结果 (1)SOD:与T0比较,对照组T3、T4时间和右美托咪定组T4时间点明显降低(P<0.05);但右美托咪定组在T3、T4时间点高于对照组(P<0.05)。MDA: 与T0比较,对照组T1~T4各个时间点和右美托咪定组T3、T4时间点均明显升高(P<0.05);但右美托咪定组T3、T4时间点低于对照组(P<0.05)。(2)TNF-α:与T0比较,对照组T1~T4各个时间点和右美托咪定组T3、T4时间点均明显升高(P<0.05);与对照组比较,右美托咪定组于T1~T4各时间点均低于对照组(P<0.05)。(3)IL-6:与T0时间点比较,对照组和右美托咪定组T1~T3时间点均无明显变化、T4时间点显著升高(P<0.05); 但右美托咪定组T4时间点显著降低(P<0.05)。结论右美托咪定以1 μg/(kg·h)的负荷量及1 μg/(kg·h)维持量持续静脉泵注,可有效降低止血带引起的下肢I/R后血清中炎性反应因子水平,减轻氧自由基所致的下肢I/RI。

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	陈晖
	郝楠楠
	雷志礼

关键词 ：右美托咪定, 止血带, 缺血/再灌注

Abstract：Objective To analyze the effect of dexmedetomidine on the level of serum inflammation cytokines and oxygen free radicals during lower extremity ischemia/refusion.Methods The study was performed on patients undergoing arthroscopic operation under spinal anesthesia. Forty patients were randomly allocated into two groups: Group control (C,n=20) and Group dexmedetomidine (D,n=20). In Group D, patients were sedated with dexmedetomidine at a continuous infusion [1 μg/kg for 10 minutes, followed by 1 μg/(kg·h)] until the end of surgery, whereas the control group received an equivalent volume of saline. Femoral venous blood samples were obtained before spinal anesthesia(T0), at tourniquet inflation 1 h(T1), after tourniquet deflation 20 minutes(T2) ,1 h(T3) and 6 h(T4) .Then the serum concentrations of SOD,MDA,TNF-α and IL-6 were measured.Results Serum SOD activity was significantly higher in the group D after tourniquet deflation 1 h and 6 h compared with those of in the group C (P<0.05) .There was a significant lowering in the serum SOD activity after tourniquet deflation 1 h and 6 h compared with the baseline in the group C(P<0.05). Serum MDA was significantly greater during ischemia and reperfusion period in the control group compared with the baseline (P<0.05) and significantly attenuated in the group D after tourniquet deflation 1 h (P<0.05) and 6 h (P<0.05).Serum TNF-α was highly elevated during ischemia and reperfusion period in the control group and the group D compared with the baseline(P<0.05) and the decrease was significantly observed in the group D compared with the group C after deflation 6 h(P<0.05). Secrum IL-6 was not significantly different in both groups at tourniquet inflation 1 h and deflation 20 min’and 1 h compared with baseline. There was a significantly greater level of IL-6 after tourniquet deflation 6 h compared with the baseline and compared with the group D (P<0.05).Conclusions Dexmedetomidine may offer advantages by inhibiting lipid peroxidation and attenuating the production of inflammatory cytokines during lower extremity ischemia/refusion injury due to tourniquet application .

Key words： Dexmedetomidine tourniquet application ischemia/ reperfusion

收稿日期: 2016-01-20

ZTFLH:

R614.2

作者简介: 陈晖,硕士,副主任医师。

引用本文:

陈晖, 郝楠楠, 雷志礼. 右美托咪定对止血带诱发下肢缺血再灌注损伤的影响[J]. 武警医学, 2016, 27(8): 826-829. CHEN Hui, HAO Nannan, and LEI Zhili. Effect of dexmedetomidine on lower extremity ischemia/refusion injury due to tourniquet application during arthroscopy. Med. J. Chin. Peop. Armed Poli. Forc., 2016, 27(8): 826-829.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2016/V27/I8/826

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