右美托咪啶对骨科止血带所致缺血-再灌注损伤的氧化应激和炎性因子的影响

The effect of dexmedetomidine on oxidative stress and inflammatory cytokines in tourniquet-induced ischemia-reperfusion injury

目的 观察右美托咪啶（DEX）对骨科止血带所致缺血-再灌注损伤氧化应激和炎性因子的影响.方法 回顾性分析80例择期行骨科下肢手术的患者资料,根据有无使用DEX分为对照组和DEX组（n=40）.所有患者均采用两点穿刺腰硬联合麻醉,完成穿刺后,DEX组静脉在10 min内给予DEX负荷剂量1μg/kg,后改为维持剂量0.5 μg/kg·;h至手术结束;对照组给予等速度、等容量的生理盐水.分别测定并比较T1（上止血带前）、T2（松止血带后10 min）、T3（松止血带后30 min）、T4（松止血带后60 min）4个时间点两组患者心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）及血清的丙二醇（MDA）、超氧化物歧化酶（SOD）、肿瘤坏死因子-α（TNF-α）和白介素-8（IL-8）的含量.结果 各个时间点的HR、MAP、SPO2两组间比较,差异均无统计学意义（P＞ 0.05）.同一组内的HR、MAP、SPO2不同时间点间比较,差异均无统计学意义（P＞0.05）.在T1时间点,两组患者血清MDA、SOD、TNF-α和IL-8含量比较差异均无统计学意义（P＞0.05）.与对照组相比,DEX组患者在T2、T3、T4时间点的血清MDA、TNF-α和IL-8含量显著降低,SOD含量显著升高,差异均有统计学意义（P＜0.05）.止血带处理后,与T1时间点相比,T2、T3、T4时间点两组患者血清MDA、TNF-α和IL-8含量显著升高,SOD含量显著降低,差异均有统计学意义（P＜0.05）.结论 DEX可以明显降低骨科止血带所致缺血-再灌注损伤引起的氧化应激和炎性因子水平.

Objective To investigate the effects of dexmedetomidine （DEX） on oxidative stress and inflammatory cytokines caused by tourniquet-induced ischemia-reperfusion injury at limbs.Methods Eighty patients who had been scheduled for lower limb operation with tourniquet were assigned equally by sequence number to use or not use DEX （DEX or control group,n =40）.Combined spinal-epidural anesthesia was performed in both groups.In the DEX group,DEX intravenous infusion was started immediately after the femoral vein cannulated at a dose of 1 μg/kg for 10 minutes,followed by 0.5 μg/kg· h until the end of operation,whereas the control group received an equivalent volume of 0.9% saline.At 10 min before tourniquet inflation （T1）,10 min （T2）,30 min （T3） and 60 min （T4） after tourniquet release,femoral venous blood samples were obtained to measure heart rate （HR）,mean arterial pressure （MAP）,saturation of pulse oximetry （SPO2）,serum malondialdehyde （MDA）,serum superoxide dismutase （SOD）,serum tumor necrosis factor-α （TNF-α） and interleukin-8 （IL-8） levels in both groups.Results There were no significant differences in HR,MAP or SPO2 at all time points between the 2 groups （P 〉 0.05）.There were no significant differences in HR,MAP or SPO2 at all time points within either group （P 〉 0.05）.There were no significant differences in serum MDA,SOD,TNF-α and IL-8 levels at T1 between the 2 groups （P〉 0.05）.The serum MDA,TNF-α and IL-8 levels were significantly lower and the serum SOD level significantly higher in the DEX group than in the control group at T2,T3 and T4,respectively （P 〈0.05）.In both groups,the serum MDA,TNF-α and IL-8 levels were significantly higher and the serum SOD level significantly lower at T2,T3 and T4 than at T1,respectively （P 〈 0.05）.Conclusion Dexmedetomidine can reduce the oxidative stress and inflammatory cytokine level which are caused by tourniquet-induced ischemia-reperfusion injury.