乌司他丁联合右美托咪定对老年糖尿病患者行胸腔镜手术后血糖水平和炎症因子的影响

Effects of ulinastatin combined with dexmedetomidine on blood glucose levels and inflammatory factors in elderly patients with diabetes after thoracoscopic surgery

目的探究乌司他丁联合右美托咪定对老年糖尿病患者行胸腔镜手术后血糖水平和炎症因子的影响。方法选择65岁以上的行胸腔镜手术的老年糖尿病患者120例,按随机数字法分为单用组和联用组,各60例。单用组患者在诱导前泵入0.5μg/kg的右美托咪定,然后以0.3μg/(kg·h)的速度持续泵注,直到手术前30 min停止;联用组患者则按照上述静脉泵注给予含乌司他丁20万单位的氯化钠混合溶液和4μg/mL的右美托咪定氯化钠混合溶液各50 mL(诱导期及维持期右美托咪定的剂量与单用组保持一致)。观察记录麻醉诱导前30 min(T1)、手术开始2 h(T2)、气管拔管即刻(T3)和术后12 h(T4)患者的心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO2),同时,采用血糖仪监测患者的血糖水平,ELISA检测患者血清中炎症因子白细胞介素(IL)-6、IL-8和肿瘤坏死因子-α(TNF-α)的表达水平。结果与T1相比,单用组患者在T2、T3时的平均动脉压(MAP)、HR明显升高(P<0.05),T4时,两组患者的MAP和HR恢复正常,而联用组患者在T2和T3时的MAP、HR均明显低于单用组(P<0.05),而术中两组患者的SpO2均无明显变化,且呼吸恢复时间、苏醒时间、VAS和Ramsay镇静评分的差异也无统计学意义(P>0.05)。手术开始后两组患者的血糖水平均明显升高(P<0.05),而在术后12 h,联用组患者的血糖水平明显低于术前的水平(P<0.05),且联用组患者在T2、T3、T4时间点上血糖水平均显著低于单用组(P<0.05)。另外,两组患者在术中和术后血清中IL-6、IL-8和TNF-α的含量均显著高于术前(P<0.05),而与单用组相比,联用组患者在T2、T3、T4时间点上血清中IL-6、IL-8和TNF-α的含量均明显下降(P<0.05)。结论乌司他丁联合右美托咪定不仅具有良好的麻醉效果,还可以降低患者的血糖水平和炎症因子的表达水平,降低炎症反应和应激反应。

Objective To investigate the clinical anesthetic effect of ulinastatin combined with dexmedetomidine for elderly patients with diabetes mellitus after thoracoscopic surgery, as well as changes in blood glucose levels and serum inflammatory factors. Methods A total of 120 elderly patients with diabetes mellitus who underwent thoracoscopic surgery from June 2016 to September 2018, who aged 65-80 years, were randomly divided into single group and combined group(n=60). The patients in the single group were pumped with a loading dose of 0.5 μg/kg dexmedetomidine sodium chloride mixed solution before induction of anesthesia, and then continuously pumped at a rate of 0.3 μg/(kg·h) until 30 minutes before the end of the operation. And the patients in the combined group were given with a mixture ulinastatin and dexmedetomidine sodium according to the above intravenous pump(induction and maintenance doses are the same as before). The heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and blood oxygen saturation(SpO2) of patients 30 minutes before induction of anesthesia(T1), 2 hours after surgery(T2), at tracheal extubation(T3), and 12 hours after surgery(T4). The radial artery blood samples were collected to monitor the blood glucose level. Enzyme-linked immunosorbent assay(ELISA) was used to detect the expression of IL-6, IL-8 and TNF-α. Results Compared with at T1, the MAP and HR of patients in the single group were significantly increased at T2 and T3(P<0.05). And at T4, the MAP and HR of the two groups returned to normal levels. The MAP and HR of the patients of combined group at T2 and T3 were significantly lower than those in the single group(P<0.05). But there was no significant change in SpO2 between the two groups during the operation. There was no significant difference in respiratory recovery time, recovery time, VAS or Ramsay sedation score between the two groups(P>0.05). The blood glucose levels of the two groups were significantly increased after the start of surgery(P<0.05), and 12 hours after surgery;the blood glucose levels of the patients in the combined group were significantly lower than the preoperative levels(P<0.05). And the blood glucose levels of the patients of combined group at T2, T3 and T4 were significantly lower than those of the single group(P<0.05). In addition, the levels of IL-6, IL-8 and TNF-α in the two groups were significantly higher than those before surgery(P<0.05). Compared with the single group, the levels of IL-6, IL-8 and TNF-α in the combined group at T2, T3 and T4 were significantly reduced(P<0.05). Conclusion Ulinastatin combined with dexmedetomidine can not only effectively maintain the anesthetic effect of thoracic surgery in elderly patients with diabetes, but also reduce the blood sugar level and inflammatory factor expression levels, and reduce the inflammatory response and stress response.