氟比洛芬酯镇痛预处理对糖尿病患者围术期氧化应激及Apelin的影响

Effect of flurbiprofen axetil pretreatment on perioperative oxidative stress and Apelin in patients with diabetes mellitus

目的探讨氟比洛芬酯镇痛预处理对合并2型糖尿病患者围术期氧化应激及Apelin的影响。方法选取择期接受脊柱手术的患者100例,将其中的65例糖尿病患者随机分为预处理组(32例)及空白对照组(33例),前者于麻醉诱导前10 min给予氟比洛芬酯注射液1.0 mg/kg预处理,后者行常规麻醉诱导,不予预处理。将35例非糖尿病患者作为正常对照组,不予预处理。观察术前(T0)、术中1 h(T1)、术后1 h(T2)各时间点的血清Apelin-13、血管紧张素Ⅱ(AngⅡ)、丙二醛(MDA)、IL-6和血糖水平变化,同时比较手术前后1 d白细胞计数(WBC)及中性粒细胞百分比(NEUT%)。结果3组患者AngⅡ、MDA、IL-6均呈现先上升(T0~T1)后回落(T1~T2)的趋势,且上述指标在T2均高于T0;而Apelin-13水平则先下降后回升,在T2低于T0(P均<0.05)。与正常对照组比较,同一时间点预处理组及空白对照组各项指标均升高,血糖波动增大,且术后WBC、NEUT%升高;与空白对照组比较,预处理组Apelin-13水平升高,IL-6、MDA、AngⅡ水平下降,术后WBC、NEUT%及血糖波动幅度均减小(P均<0.05)。结论氟比洛芬酯预处理可调节血清Apelin-13水平,在一定程度上降低炎症因子及氧化应激指标水平,抑制术后WBC和NEUT%的升高,改善2型糖尿病患者围术期氧化应激和血糖波动。

Objective To investigate the effect of flurbiprofen axetil pretreatment on perioperative oxidative stress and Apelin in patients with type 2 diabetes mellitus. Methods A total of 100 patients scheduled to undergo spinal surgery were recruited.Among them, 65 patients with diabetes mellitus were randomly divided into the pretreatment group(n = 32) and blank control group(n = 33). In the pretreatment group, patients were pretreated with flurbiprofen axetil injection at a dose of 1.0 mg/kg at 10 min before anesthesia induction, and those in the blank control group received routine anesthesia without pretreatment. Non-diabetic patients were assigned into the normal control group(n = 35), who were not given with pretreatment. The changes of the serum levels of Apelin-13, Ang Ⅱ, MDA, IL-6, blood glucose were observed at preoperative(T0), intraoperative 1 h(T1) and postoperative 1 h(T2) time points, respectively. Meantime, the white blood cell count(WBC)and neutrophil percentage(NEUT%) were compared before and 1d after operation. Results The serum levels of Ang Ⅱ, MDA and IL-6 in all three groups showed a trend of initial increase(T0-T1) and then decline(T1-T2), and the levels at T2 were higher than those at T0. However, the serum levels of Apelin-13 were initially decreased and then increased, and the levels at T2 were significantly lower compared with those at T0(all P < 0.05). Compared with the normal control group, all serum indexes at the same time point were increased, blood glucose fluctuation was enlarged, and postoperative WBC and NEUT% were increased in the pretreatment and blank control groups. Compared with the blank control group, the serum level of Apelin-13 was significantly up-regulated, those of IL-6, MDA and Ang Ⅱ were significantly decreased, and postoperative WBC, NEUT%and blood glucose fluctuation were significantly decreased in the pretreatment group(all P < 0.05). Conclusion Flurbiprofen axetil preconditioning can regulate the serum level of Apelin-13, lower inflammatory factors and oxidative stress indexes to certain extent, inhibit the increase of WBC and NEUT% after operation, and mitigate perioperative oxidative stress and blood glucose fluctuation in diabetic patients.