不同镇静深度下右美托咪定减轻上肢缺血再灌注后心肌损伤的效果观察

Effect of different sedation depth of dexmedetomidine relieve myocardial damage included by upper limb ischemia reperfusion injury

目的比较不同镇静深度下右美托咪定减轻上肢缺血再灌注后心肌损伤的效果。方法选择ASAⅠ~Ⅱ级使用止血带时间大于1小时的择期单侧上肢前臂手术病人40例,按照完全随机方法将受试对象分为4组,C组(对照组)、D组(BIS值为60~70)、E组(BIS值为70~80)、F组(BIS值为80~90),每组10例。分别于上止血带前(T_0),松止血带后30分钟(T_1)、2小时(T_2)、4小时(T_3)各时点,抽取静脉血4ml。记录各时间点的心率、血压和血氧饱和度以及抽血采用ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6),硫代巴比妥酸法检测过氧化物丙二醛(MDA),速率法检测肌酸激酶(CK)和乳酸脱氢酶(LDH)。结果 4组的各时点血氧饱合度和T_0及T_(2~3)时点血压和心率均未见明显差异,D、E和F组在T1时均出现血压和心率的下降,C组和D、E、F组在T_(1~3)时点血浆TNF-α与MDA及T_(2-3)时点血浆IL-6、CK、LDH浓度均升高(P<0.05)。与C组比较,D和E、F组在T_(1~3)时点血浆TNF-α与MDA及T_(2~3)时点血浆IL-6、CK、LDH浓度均降低(P<0.05)。与E和F组比较,D组在T_(1~3)时点血浆TNF-α与MDA及T_(2~3)时点血浆IL-6、CK、LDH浓度均降低(P<0.05)。结论不同镇静深度下右美托咪定均能减轻止血带所致缺血再灌注损伤的炎性反应及心肌损伤,且这种效果于镇静深度BIS值为60~70为佳。

Objective To compare the different depth of sedation under dexmedetomidine reduce myocardial injury after ischemia reperfusion effect of upper limb. Methods 40 ASA I~Ⅱ caseswhoseusing tourniquet time greater than 1 hours of elective unilateral upper forearm surgery pa-tients were selected, according to random subjects are divided into four groups：group C（control group）, group D（BIS 60 ~70）,group E（BIS 70~80）and F group（BIS 80~90）, 10 cases in each group. Respectively before tourniquet（T_0）, 30 min after tourniquet release（T_1）, 2 h（T_2）, 4 H（T_3） at each time point, blood samples（4 ml） were acquired. The date of heart rate, blood pressure and oxygen saturationwere recorded.The necrosis factor alpha（TNF-α） and interleukin 6（IL-6） of blood sampleswere detected by ELISA method.The peroxides malondialdehyde（MDA） were detected bythiobarbituric acid method.The creatine kinase（CK）, and lactate dehydrogenase（LDH） were assayed by rate method. Results The oxygen saturation at each time pointand blood pressure and heart rateat T_0 and T_（2-3） point had no significant difference inthe four groups. The blood pressure and heart rate in group D,E and F at T_1 were decreased.The plasma TNF-a and MDA in group C and group D, E, F at T__（1-3） point,IL-6, CK, LDH concentration at T__（2-3） group were increased（P〈0.05）. Compared with group C,group D,E and F in T_1-3 TNF-αand MDA and T__（2-3） IL-6, CK, LDH was lower（P〈0.05）. With the groups E and F,groups D in the T__（1-3） TNF-αand MDA and T_（2-3） IL-6, CK, LDH was lower（P〈0.05）. Conclusion Different sedative depth under dexmedetomidine can reduce tourniquet induced ischemia-reperfusion injury of inflammatory response and myocardial injury, and this effect is in the depth of se-dation BIS value of 60~70 is better.