右美托咪定结合超声技术对患者下肢手术中止血带所致氧化应激及炎症反应的影响

Dexmedetomidine combined with ultrasonic technique on tourniquet-induced oxidative stress and inflammation response in patients with lower limb surgery

目的探讨右美托咪定结合超声技术对患者下肢手术中止血带所致氧化应激及炎症反应的影响。方法单侧下肢手术患者60例,性别不限,年龄18~60岁,体重指数21~26 kg/m2,ASA分级Ⅰ级或Ⅱ级,预计手术时间在1~1.5 h,根据随机数字表,将其分为三组各20例。均采用蛛网膜下腔阻滞麻醉(腰麻),使用止血带10 min前,Ⅰ组、Ⅱ组患者在10 min内给予负荷量0.5μg/kg右美托咪定静脉泵注,随后采用0.5μg/(kg·h)维持至术毕,Ⅲ组患者给予同剂量、同速率生理盐水泵注和维持;Ⅰ组患者依靠超声技术判断止血带的最佳压力,Ⅱ组和Ⅲ组采用常规充气压力。分别于腰麻穿刺后(T0)、止血带放气即刻(T1)、止血带放气后60 min(T2)采集术侧上肢静脉血样,测定血浆丙二醛(MDA)、超氧化物歧化酶活性(SOD)、白细胞介素-8(IL-8)和人肿瘤坏死因子-α(TNF-α)。结果与T0时点比较:T1、T2时点三组血浆MDA和TNF-α浓度明显升高,SOD浓度下降,T2时IL-8升高(P<0.05);与Ⅲ组比较:T1时Ⅰ组、Ⅱ组血浆MDA及TNF-α浓度较低,SOD较高(P<0.05),T2时Ⅰ组SOD值最高,MDA和TNF-α值最低(P<0.05);T2时,Ⅰ组、Ⅱ组血浆IL-8低于Ⅲ组(P<0.05)。结论右美托咪定结合超声技术用于下肢手术,可有效减少使用止血带所导致的氧化应激及炎症反应。

Objective To evaluate effect of dexmedetomidine combined with ultrasonic technique on tourniquet-induced oxidative stress and inflammatory responses in patients with lower limb surgery.Methods 60 patients who underwent unilateral lower limb surgery,with ASA physical statusⅠorⅡgrade,aged 18 ~ 60 years,body mass index was 21 ~ 26 kg/m2,predicted duration of surgery was 1 ~ 1.5 h,were divided into 3 groups( with 20 cases in each group) by random number table method.All groups were given subarachnoid block anesthesia( lumbar anesthesia).10 min before the use of tourniquet,groupⅠand groupⅡwere given load of 0.5 g/kg of dexmedetomidine by intravenous infusion within 10 min,and then 0.5 μg/( kg·h) of it were given to the patients until the surgery was finished.Group Ⅲ were given the same dose and same rate of saline infusion by intravenous infusion to maintain the surgery.The group Ⅰ relied on ultrasound technology to judge the optimum pressure of tourniquet,but the group Ⅱ and group Ⅲ relied on conventional pneumatic pressure.Upper extremity venous blood sample in the operated side were selected after lumbar anesthesia puncture( T0),at time of tourniquet deflation( T1) and 60 minutes after tourniquet deflation( T2),respectively.And then,plasma malondialdehyde( MDA),superoxide dismutase( SOD) activity,interleukin-8( IL-8) and human tumor necrosis factor alpha( TNF-α) were tested.Results Compared with the results at T0,the concentrations of plasma MDA and TNF-a increased,but the concentration of SOD decreased at T1 and T2,and IL-8 at T2 increased among all the three groups( P<0.05).Compared with the group Ⅲ,groupⅠand groupⅡhad lower concentrations of MDA and TNF-α,and had higher SOD at T1( P<0.05).At T2,SOD of the groupⅠwas highest,but MDA and TNF-α were lowest( P<0.05).In addition,plasma IL-8 of the groupⅠand groupⅡat T2 was lower than that of the group Ⅲ( P < 0. 05).Conclusion Dexmedetomidine combined with ultrasonic technique for lower limb surgery can efficiently reduce tourniquetinduced oxidative stress and inflammatory responses.