右美托咪定对全身麻醉下单膝关节置换止血带反应的抑制效果分析

Inhibitory effects of dexmedetomidine on the tourniquet reaction during unilateral knee joint replacement under general anesthesia

目的探讨右美托咪定对全身麻醉下单膝关节置换止血带反应的抑制效果分析。方法将2016年7月至2017年7月行全身麻醉下单膝关节置换术的90例患者随机分为2组,每组45例。观察组给予右美托咪定抑制止血带反应,对照组给予等量0. 9%氯化钠溶液。比较2组患者不同时间点的止血带相关高血流动力学反应情况、机体缺血再灌注损伤情况。结果比较2组上止血带前(T0)、止血带充气时(T1)、止血带充气30 min(T2)、止血带充气60 min(T3)、止血带充气90 min(T4)、松止血带时(T5)、松止血带后10 min(T6)、松止血带后30 min(T7),观察组T1～T5时HR、MAP、SBP与对照组相比明显降低,SPO2明显升高(P <0. 05),2组T1～T5时HR、MAP、SBP、SPO2均与T0差异有统计学意义(P <0. 05);观察组T5～T7时MDA、SOD、OH、H2O2、TNF-α和IL-8与对照组比较差异有统计学意义(P <0. 05)。结论右美托咪定对全身麻醉下单膝关节置换止血带反应的抑制效果显著,能有效减少血流动力学波动,降低缺血再灌注损伤,减轻炎性反应和氧化应激反应,具有积极的临床意义。

Objective To investigate the inhibitory effect of dexmedetomidine on the tourniquet reaction during unilateral knee joint replacement under general anesthesia.Methods Ninety patients undergoing unilateral knee joint replacement under general anesthesia in our hospital from July 2016 to July 2017 were randomly divided into 2 groups,with 45 patients in each group.The patients in observation group were given dexmedetomidine to inhibit the tourniquet reaction,and those in the control group were given an equal amount of 0.9%sodium chloride solution.The hemorrhage-related hyperhemodynamic response and ischemia-reperfusion injury of the two groups were compared at different time points.Results In the two groups before tourniquet inflation(T0),immediately after tourniquet inflation(T1),30 min after tourniquet inflation(T2),60 min after tourniquet inflation(T3),90 min after tourniquet inflation(T4),immediately after tourniquet deflation(T5),10 min after tourniquet deflation(T6),and 30 min after tourniquet deflation(T7),HR,MAP,and SBP at T1~T5 in observation group were significantly lower than those in control group,whereas SPO 2 was significantly increased(P<0.05).HR,MAP,SBP,and SPO 2 at T1~T5 were significantly different from those at T0 in both groups(P<0.05).There were significant differences in the levels of MDA,SOD,OH,H 2O 2,TNF-αand IL-8 at T5~T7 between observation group and control group(P<0.05).Conclusion The dexmedetomidine has significant inhibitory effects on tourniquet reaction during unilateral knee joint replacement under general anesthesia,which can effectively reduce hemodynamic fluctuations,ischemia-reperfusion injury,inflammatory response and oxidative stress.Therefore,it is of positive significance in clinical practice.