全膝关节置换术中应用右美托咪定减轻肢体缺血再灌注损伤的效果研究

The application of Dexmedetomidine in total knee arthroplasty on limb ischemiareperfusion injury

目的:探讨全膝关节置换术中应用右美托咪定减轻肢体缺血再灌注损伤的效果。方法:回顾性收集收治的全膝关节置换术治疗的患者80例作为研究对象,随机分为右美托咪定组及观察组;两组患者均常规实施腰-硬联合阻滞麻醉,在上止血带前20 min对照组采取生理盐水处理,右美托咪定组则采取右美托咪定处理,记录并对比分析两组患者进入手术室后、松止血带时、松止血带半小时后患者的静脉血情况,包括肿瘤坏死因子α(TNF-α)、血浆丙二醛(MDA),同时观察心动过缓与恶心、呕吐等情况。结果:两组患者在松止血带时、松止血带半小时后TNF-α、MDA均明显高于进入手术室后,差异有统计学意义(P<0.05);右美托咪定组松止血带时、松止血带半小时后TNF-α、MDA水平明显低于对照组,差异有统计学意义(P<0.05);研究组心动过缓发生率明显高于对照组,但高血压与止血带疼痛等则明显低于对照组,组间比较差异有统计学意义(P<0.05)。结论:全膝关节置换术中应用右美托咪定在一定程度上可以减轻肢体缺血再灌注损伤,但应预防心动过缓等并发症的发生。

Objective To explore the effect of Dexmedetomidine in total knee arthroplasty on limb ischemiareperfusion injury.Method80cases of patients with total knee replacement treatment were collected,they were randomly divided into the Dexmedetomidine group and observation group.Two groups of patients were regular implementation waist hard joint block anesthesia,20min before the tourniquet on the control group was given the physiological saline,Dexmedetomidine group was taken Dexmedetomidine,recording and analysising the two groups of patients after entering the operating room,loose the tourniquet,loose tourniquet half an hour later the venous blood of patients.The tumor necrosis factor alpha(TNF alpha),plasma malondialdehyde(MDA)and untoward effect were compared.Results The TNF-αand MDA Increased significantly after the operation;There were significant differences in two group(P<0.05).The TNF-αand MDA was significantly higher than the control group(P<0.05).Bradyarrhythmia Dexmedetomidine group were significantly higher than the control group,however the high blood pressure,pain and a tourniquet was significantly lower than the control group(P<0.05).Conclusion The application of Dexmedetomidine in total knee arthroplasty on limb ischemiareperfusion injury can alleviate ischemia reperfusion injury,however it is necessary to take precautions against bradyarrhythmia.