右美托咪定对胰肾联合移植术胰腺缺血-再灌注损伤的保护作用

Protective effect of dexmedetomidine on pancreatic ischemia-reperfusion injury after combined transplantation of pancreas and kidney

目的探讨右美托咪定对胰肾联合移植术胰腺缺血-再灌注损伤的保护作用。方法60例行胰肾联合移植术患者均分为右美托咪定(D)组和对照(C)组。麻醉诱导后,D组静脉输注右美托咪定0.5μg/kg(12 min内),继之0.5μg·kg~(-1)·h~(-1)静脉泵注至手术结束。C组相同时点静脉输注等容量生理盐水。麻醉诱导后(T0)、切皮前(T1)、肾动静脉开放后30 min(T2)、胰腺相关动静脉开放后30 min(T3)、术毕(T4)、术后4 h(T5)及24 h(T6)检测两组血清炎症因子[TNF-α、IL-6、IL-18和细胞间黏附分子1(ICAM-1)]和氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)及谷胱甘肽过氧化物酶(GSH-Px)]。记录术前、术毕和术后的尿量,并检测血肌酐、空腹血糖、C肽和血清淀粉酶。记录术后气管插管带管时间、ICU停留时间以及术后移植物排斥反应发生情况。结果与C组比较,D组T2~T6时血清TNF-α和ICAM-1水平降低,T2~T4时血清IL-6水平降低,T3~T6时血清IL-18水平降低(P<0.05)。与C组比较,D组T2~T6时血清MDA水平降低,T3~T6时血清SOD和GSH-Px水平升高(P<0.05)。与术前比较,两组术毕及术后尿量和C肽增高,而血肌酐和空腹血糖降低(P<0.05),血清淀粉酶仅术后降低(P<0.05)。两组术后气管插管带管时间、ICU停留时间以及术后移植物排斥反应发生率相仿(P>0.05)。结论右美托咪定可以减轻胰肾联合移植术中胰腺缺血-再灌注损伤,对移植器官有一定保护作用。

Objective To explore the protective effect of dexmedetomidine on the pancreatic ischemia-reperfusion injury after combined transplantation of the pancreas and kidney(CTPK).Methods Sixty patients undergoing CTPK were divided into two groups with 30 cases each.After anesthesia induction,dexmedetomidine 0.5μg/kg was infused intravenously within 12 minutes in group D,which was followed by dexmedetomidine 0.5μg·kg-1·h-1 intravenously until the end of surgery.Normal saline instead of dexmedetomidine was used in group C.Serum levels of TNF-α,IL-6,IL-18 and intercellular adhesion molecule 1(ICAM-1),malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in both groups were detected at the time points of after anesthesia induction(T0),before skin incision(T1),at 30 minutes after renal arteriovenous opening(T2),30 minutes after pancreatic arteriovenous opening(T3),at the end of surgery(T4),at the 4th hour(T5)and 24th hour(T6)after surgery.At the times of before,at the end of and after surgery,urine volume was recorded and creatinine,fasting blood glucose,C peptide and serum amylase were detected.Postoperative endotracheal intubation time,ICU stay and postoperative graft rejection were recorded.Results Compared with group C,serum levels of TNF-αand ICAM-1 at T2 to T6 in group D were decreased,serum IL-6 level at T2 to T4 was decreased,and serum IL-18 level at T3 to T6 was decreased in group D(P<0.05).Compared with group C,serum MDA level at T2 to T6 was decreased,while serum SOD and GSH-Px levels at T3 to T6 were increased in group D(P<0.05).Compared to before,at the end of and after surgery,urine volume and C-peptide were increased,while serum creatinine and fasting blood glucose were decreased in both groups(P<0.05).Compared to before,serum amylase was decreased after surgery in both groups(P<0.05).The postoperative endotracheal intubation time,ICU stay and postoperative graft rejection rate of both groups were similar(P>0.05).Conclusion Dexmedetomidine can reduce pancreatic ischemia-reperfusion injury and protect transplanted organs in the patients undergoing CTPK.