右美托咪定对骨折手术患者止血带所致炎症反应的影响

Effect of dexmedetomidine on inflammatory response related with application of air pressure tourniquet

目的 观察右美托咪定对骨折手术患者止血带所致炎症反应的影响。方法 择期行单侧胫腓骨骨折切开复位内固定术的患者75例,男38例,女37例,年龄25~88岁。所有患者被随机均分为三组,每组25例,分别为：C组（不使用止血带和右美托咪定）,T组（使用止血带但不使用右美托咪定）和D组（使用止血带和右美托咪定）。术中采用全凭静脉麻醉,D组在诱导前以右美托咪定0.1μg/（kg·min）持续泵入10 min,诱导成功后改为0.4μg/（kg·h）持续泵注至手术结束前30 min;C组和T组泵以等量生理盐水。记录泵注右美托咪定或生理盐水前5 min（T_0）、止血带充气前1 min（T_1）、充气后30 min（T_2）、止血带放气即刻（T_3）、放气后30 min（T_4）抽取动脉血3 ml,测定血浆TNF-α、IL-6和IL-10含量。结果与C组比较,T组T_2~T_4时TNF-α、IL-6含量明显升高,T_3、T_4时IL-10含量明显升高（P〈0.05）;D组T_2~T_4时IL-6含量明显升高,T_3时TNF-α含量明显升高,T_3、T_4时IL-10含量明显升高（P〈0.05）。与T组比较,D组T_2~T_4时TNF-α、IL-6含量明显降低,T_3、T_4时IL-10含量明显升高（P〈0.05）。结论 单侧胫腓骨骨折切开复位内固定术中止血带可促进患者炎症反应,而右美托咪定可抑制炎症反应的程度。

Objective To investigate the effects of dexmedetomidine on inflammatory response related with the use of air pressure tourniquet. Methods Seventy-five patients including 38 males and 37 females scheduled for open reduction internal fixation of unilateral tibiofibula fractures were selected,the age of the patients were between 25 and 88 years old. All patients were randomly divided into three groups,with 25 patients in each group, named group C（ without the use of an air pressure tourniquet or intravenous infusion of dexmedetomidine）,group T（ with the use of an air pressure tourniquet but without intravenous infusion of dexmedetomidine）,and group D（ with the use of an air pressure tourniquet and intravenous infusion of dexmedetomidine）. The operation was performed under total intravenous anesthesia,patients in group D were infused dexmedetomidine 0. 1μg /（ kg·min） for 10 minutes before induction,the infusion rate were turned into0. 4μg /（ kg·h） after then until 30 minutes before end of the surgery,while group C and group T infused with normal saline with the same rate. The plasma level of TNF-α,IL-6,IL-10 of patients in each group were measured at T_0（ 5 minutes before the infusion of dexmedetomidine or normal saline）,T_1（ 1 minute before the infusion of dexmedetomidine or normal saline）,T_2（ 30 minutes after the inflation of tourniquet）,T_3（ the time when deflating the tourniquet）,and T_4（ 30 minutes after deflation of the tourniquet）. Results Compared to group C,the plasma level of TNF-α and IL-6 of group T were significantly higher at the point of time T_2,T_3 and T_4,plasma level of IL-10 of group T was higher at T_3 and T_4（ P〈0. 05）. The plasma level of IL-6 of group D was much higher at the point of time T_2,T_3 and T_4,level of TNF-αof group D was higher at T_3,level of IL-10 of group D was higher at T_3 and T_4,（ P〈0. 05）. Compare to group T,level of TNF-α and IL-6 of group D were significantly lower,while IL-10 of the same group was significantly higher at the point of time T_3 and T_4.Conclusions Air pressure tourniquet may produce proinflammatory effect during open reduction internal fixation of unilateral tibiofibula fractures,and the injection of dexmedetomidine could alleviate this side effects of air pressure tourniquet.