糖尿病对肢体缺血再灌注后患者炎症反应和肺功能的影响

The effect of diabetes on inflammatory response and pulmonary function in patients undergoing limb ischemia-reperfusion

目的：观察2型糖尿病对止血带所致缺血再灌注后患者炎症反应和肺换气功能的影响及与血糖控制水平和病程的相关性。方法：择期拟行单侧下肢手术患者85例,分为糖尿病组（n=55）和对照组（n=30）,并根据糖化血红蛋白（Hb A1c）水平和病程分为不同亚组。患者选择硬膜外麻醉,常规使用止血带1~1.5h,分别在扎止血带前（T0）、松止血带后2h（T1）、6h（T2）和24h（T3）行动脉血气分析,并测定血清肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）浓度。结果：与基础值比较,2组患者T1~T3时点血清TNF-α和IL-6浓度上升,T2时点肺泡-动脉氧分压差（PA-aDO2）和呼吸指数（RI）增加（P〈0.05）;与对照组比较,糖尿病组T1、T2时点血清TNF-α和IL-6浓度升高,T2时点PA-aDO2和RI增加（P〈0.05）,且与血糖控制水平和病程相关。结论：2型糖尿病可加重肢体缺血再灌注所致炎症递质释放和肺换气功能损伤,其程度与血糖控制水平与病程相关。

Objective： To investigate the effect of type 2 diabetes on inflammatory response and pulmonary function in patients undergoing limb ischemia-reperfusion induced by tourniquet, and to study its relationships with blood glucose control level and disease duration. Methods： Eight-five patients scheduled for unilateral lower extremity surgery were enrolled and divided into Diabetes（n=55） and Control（n=30） Group, Diabetes Group was allocated into several sub-groups according to blood glucose control level and disease duration, respectively. The patients received epidural anesthesia and radial arteries catheterization, and the tourniquet duration lasted for 1-1.5 h. The arterial blood gases and serum Tumor Necrosis Factor-α（TNF-α） and interleukine-6（IL-6） were measured immediately before tourniquet inflation, 2 h, 6 h and 24 h after tourniquet deflation. Results： Serum levels of TNF-α and IL-6 were significantly elevated at 2 h, 6 h and 24 h after tourniquet deflation, and the values of alveolar-arterial oxygen tension difference（PA-aDO2） and respiratory index（RI） were increased were increased at 2 h and 6 h after tourniquet deflation in both two groups（P〈0.05）. As compared to Control Group, the serum levels of TNF-α and IL-6 were higher, and PA-aDO2 and RI values were larger in Diabetes Group at 6h after tourniquet deflation（P〈0.05）, which were closely related to blood glucose control level and disease duration. Conclusion： Type 2 diabetes aggravates the inflammatory mediators release and pulmonary gas exchange function, which relates to blood glucose control level and disease duration.