DEX对骨科止血带所致缺血再灌注患者炎症反应、氧化应激及内皮功能的影响

Effects of DEX on inflammation,oxidative stress and endothelial function in patients with ischemia-reperfusion injury caused by orthopedic tourniquet

目的:右美托咪定(dexmedetomidine,DEX)对骨科止血带所致缺血再灌注患者炎症反应、氧化应激及内皮功能的影响。方法:选取我院收治的拟行骨科下肢手术的患者120例,依据随机数据表法分为观察组和对照组,每组60例。所有患者均选择蛛网膜下腔阻滞联合硬膜外麻醉,观察组在上止血带前在10min静脉推注DEX,负荷剂量1μg/kg,后改为维持剂量0.5μg/(kg·h)直至手术结束,对照组静脉推注等速度、等容量的生理盐水。分别检测并比较两组上止血带前(T0)、松止血带后10 min(T1),60min(T2)及120min(T3)时患者体内血清的炎症因子(IL-8、TNF-α)、氧化应激指标(SOD、MDA)及内皮功能(ET-1、NO)水平变化。结果:观察组与对照组患者在T0时间点IL-8、TNF-α、SOD、MDA、ET-1及NO水平比较,差异均无显著性意义(P>0.05)。与T0相比,两组松止血带后T1、T2、T3三个时间点IL-8、TNF-α、MDA、ET-1水平均显著升高(P<0.05),SOD、NO水平均显著降低,差异均有显著性意义(P<0.05)。此外,观察组在松止血带后T1、T2、T3三个时间点的IL-8、TNF-α、MDA、ET-1水平显著低于对照组(P<0.05),SOD、NO的水平显著高于对照组,差异均有显著性意义(P<0.05)。结论:骨科手术过程中,DEX可减轻患者因使用止血带引起的缺血-再灌注损伤(ischemiareperfusion injury,I-R)所诱发的炎症反应、氧化应激反应及内皮功能障碍,有利于患者术后恢复,具有重要的临床价值。

Objective：To investigate the effects of dexmedetomidine on inflammation,oxidative stress and endothelial function in patients with ischemia-reperfusion injury caused by orthopedic tourniquet.Methods：According to random data table method,a total of 120 patients who were scheduled for lower limb surgery from August 2016 to April 2017 were divided into observation group and the control group,60 cases in each group.Both groups were treated with subarachnoid block combined with epidural anesthesia,the observation group was given intravenous injection of DEX 10 min before the tourniquet（load dose 1μg/kg）,follwed by the maintenance dose of 0.5μg/（kg·h）until the end of surgery;the control group were given intravenous injection of the same speed,equal volume of saline.The levels of inflammatory factors（IL-8,TNF-α）,oxidative stress（SOD,MDA）and vascular endothelial function（ET-1,NO）were detected before tourniquet inflation（T0）,10 min（T1）,60 min（T2）and 120 min（T3）after tourniquet release.Results：The levels of IL-8,TNF-α,SOD,MDA,ET-1 and NO in the control group and the observation group at time T0 were not statistically significant（P〉0.05）.Compared with T0,the levels of IL-8,TNF-α,MDA and ET-1 were significantly higher（P〈0.05）and the levels of SOD and NO were significantly lower（P〈0.05）in the two groups at T1,T2,T3 after tourniquet release,the difference was statistically significant（P〈0.05）.In addition,the levels of IL-8,TNF-α,MDA and ET-1 in the observation group were significantly lower than those in the control group and the levels of SOD and NO were significantly higher than those in the control group at T1,T2 and T3 after the tourniquet,the difference was significant（P〈0.05）.Conclusion：During the course of orthopedic surgery,DEX can alleviate the inflammatory response,oxidative stress and endothelial dysfunction induced by ischemia-reperfusion injury（I-R）caused by tourniquet,which is beneficial to the patient＇s postoperative recovery and has important clinical value.