右美托咪定对下肢止血带手术糖尿病患者氧化应激和心肌损伤的影响

Protective effect of dexmedetomidine against oxidative stress response and myocardial injury caused by lower limb tourniquet surgery in diabetic patients

目的观察术中应用右美托咪定是否能够减轻糖尿病患者的氧化应激反应,降低下肢止血带手术引起的心肌损伤。方法选择择期全身麻醉下接受骨科下肢手术需用止血带的患者80例,其中2型糖尿病患者40例,非糖尿病患者40例,按随机数字表法分为糖尿病右美托咪定组(D1,n=20),非糖尿病右美托咪定组(D2,n=20),糖尿病非右美托咪定组(C1,n=20)和非糖尿病非右美托咪定组(C2,n=20)。D1、D2组给予右美托咪定(初始剂量1μg/kg,维持剂量0.5μg·kg^-1·h^1至术毕),C1、C2组以相同的方法给予生理盐水。分别于上止血带前(T0)和松止血带后15min(T1)、1h(T2)、24h(T3)4个时间点采集静脉血测定丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、白细胞介素1β(interleukin-1β,IL-1β)、肌钙蛋白I(cardiac troponinI,cTnI)浓度。结果4组MDA从T0~T2逐渐升高,到T3时下降,其组间、时点间差异均有统计学意义(P<0.05);4组SOD从T0~T2逐渐降低,到T3升高,其组间、时点间及组间·时点间交互作用差异均有统计学意义(P<0.05)。4组IL-1β和cTnI均从T0~T2逐渐升高,到T3时下降,组间、时点间及组间·时点间交互作用差异均有统计学意义(P<0.05)。结论糖尿病患者行下肢止血带手术更容易因缺血再灌注导致氧化应激和心肌损伤,右美托咪定能减轻其氧化应激反应,产生有效的心肌保护作用。

Objective To observe whether application of dexmedetomidine can reduce the oxidative stress response of diabetic patients and reduce the myocardial injury caused by lower limb tourniquet surgery. Methods Eighty patients under general anesthesia were accepted lower limb orthopedic surgery, forty patients with type 2 diabetes, forty patients without diabetes, were randomly divided into four groups using a random number table: diabetes dexmedetomidine group(D1, n =20), non-diabetic dexmedetomidine group(D2, n =20), diabetic non-dexmedetomidine group(C1, n =20) and non-diabetic non-dexmedetomidine group(C2, n =20). In the test group D1 and group D2,dexmedetomidine 1μg/kg(initial dose) was given(15 min) after induction of anesthesia, followed by continuous infusion at 0.5 μg·kg ^-1 ·h ^-1 , until the end of operation. The equal volume of normal saline was given instead of dexmedetomidine in control group C1 and group C2. Before the tourniquet(T0), after loose tourniquet 15 min(T1), 1 h (T2) and 24 h(T3), blood samples were collected for determination of malondialdehyde(MDA), superoxide dismutase(SOD), interleukin-1β(IL-1β), cardiac troponin I(cTnI) concentrations. Results The concentration of MDA in the four groups were firstly increased at T0~T2 and then decreased at T3, there were statistically significant differences between groups and time points( P < 0.05), while there was no significant difference between their interactions( P < 0.05). The SOD were gradually decreased at T0~T2 and then increased at T3, while the levels of IL-1β and cTnI were firstly increased at T0~T2 and then decreased at T3 in the four groups, there were statistically significant differences between groups, time points and their interactions( P < 0.05). Conclusion dexmedetomidine can reduce the oxidative stress response of diabetic patients, reduce the myocardial injury caused by lower limb tourniquet surgery, and produce effective myocardial protection.