右美托咪定在老年2型糖尿病患者止血带下肢手术中的应用

Application of dexmedetomidine in tourniquet lower limb surgery in elderly patients with type 2 diabetes mellitus

目的探讨右美托咪定(DEX)对下肢手术2型糖尿病老年患者使用止血带后血清神经元特异性烯醇化酶(NSE)、氧化应激反应、炎症反应及术后认知功能的影响。方法选择全麻止血带下行骨科下肢手术的老年2型糖尿病患者96例,采用随机数字表法分为DEX组和对照组,各48例。DEX组于全麻诱导后15 min内静脉泵注DEX0.5μg/kg,继之以0.5μg/(kg·h)泵注直至手术结束前30 min,对照组给予相同容量生理盐水。分别于止血带充气前,放气后30 min、24 h和72 h采用硫代巴比妥酸法、双抗体夹心酶联免疫吸附试验(ELISA)法检测2组患者血清丙二醛(MDA)、NSE、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β水平;采用简易精神状态评价量表(MMSE)法评定2组患者术前1 d,术后1 d、3 d认知功能;记录2组苏醒时间、拔管时间、不良反应情况。结果与充气前比较,2组血清NSE水平从放气后24 h开始增加,而MDA、TNF-α、IL-1β水平从放气后30 min即开始增加(P<0.05);与对照组比较,DEX组血清NSE水平从放气后24 h开始降低,而MDA、TNF-α、IL-1β水平从30 min即开始降低(P<0.05);与术前1 d比较,2组术后1 d、3 d的MMSE评分均降低(P<0.05);与对照组比较,DEX组MMSE评分在术后1 d、3 d升高(P<0.05)。2组苏醒时间、拔管时间、不良反应发生率比较差异均无统计学意义。结论 DEX用于2型糖尿病老年患者止血带下肢手术可降低血清NSE,减轻氧化应激及炎症反应,改善术后认知功能。

ObjectiveTo investigate the impact of dexmedetomidine(DEX) on serum neuron-specific enolase(NSE),oxidative stress, inflammatory response and postoperative cognitive function after lower limb tourniquet surgery in elderly patients with diabetes.MethodsA total of 96 elderly patients with type 2 diabetes mellitus who underwent lower extremity surgery under selective general anesthesia tourniquet were randomly divided into DEX group and control group by using a random number table method, 48 cases in each group. After induction of general anesthesia, the DEX group was pumped with 0.5 μg/kg DEX within 15 min, followed by an infusion of 0.5 μg/(kg·h) until 30 min before the end of the operation. The control group was pumped with the same volume of normal saline. The serum levels of malonaldehyde(MDA), NSE,tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β) were detected by thiobarbituric acid and enzyme-linked immunosorbent assay(ELISA) before using the tourniquet, 30 min, 24 h and 72 h after releasing the tourniquet. The minimental state examination(MMSE) was used to evaluate cognitive function 1 d before operation, 1 d and 3 d after operation.The awake time, extubation time and adverse reactions were recorded in the two groups.Results Compared with before using the tourniquet, the level of NSE increased from 24 h after releasing the tourniquet in both groups, while the levels ofMDA, TNF-α and IL-1β increased from 30 min after releasing the tourniquet(P<0.05). Compared with the control group,the level of NSE decreased from 24 h after tourniquet release in the DEX group, while the levels of MDA, TNF-α and IL-1βdecreased from 30 min after tourniquet release(P<0.05). Compared with 1 day before surgery, MMSE scores were decreasedat the 1 d and 3 d after surgery in both groups(P<0.05). Compared with the control group, MMSE scores increased at the 1 dand 3 d after surgery in DEX group(P<0.05). There were no significant differences in wake time, extubation time andincidence of adverse reactions between the two groups.ConclusionDexmedetomidine can reduce serum NSE, reduceoxidative stress and inflammation response, and improve postoperative cognitive function on lower limb tourniquet surgery inelderly patients with diabetes.