恒速泵注甲氧明在糖尿病患者下肢止血带术中的作用

The role of constant-speed pump infusion of methoxamine in lower limb tourniquet operation in patients with diabetes mellitus

目的观察下肢止血带术中恒速泵注甲氧明对糖尿病患者血流动力学、心肌损伤及氧化应激的影响。方法将接受单侧膝关节置换术的60例糖尿病患者随机分为甲氧明组和对照组各30例,前者在平面固定后静脉泵注甲氧明[2μg/(kg·min)],后者泵注等量生理盐水。于松止血带前(T0)、松止血带后10 min(T1)、松止血带后30min(T2)检测血清心肌肌钙蛋白T(cTnT)、丙二醛(MDA)、IL-6及Apelin-13水平,观察患者T0~T2的心率(HR)、平均动脉压(MAP)及心电图变化,并记录不良反应。结果与对照组比较,甲氧明组T0~T2的HR和MAP更平稳,心电图ST-T段改变的发生率更低(P均<0.05)。2组患者T1、T2的血清cTnT、MDA、IL-6水平均升高,血清Apelin-13水平降低;甲氧明组T1、T2的血清cTnT、MDA、IL-6水平均低于对照组,血清Apelin-13水平高于对照组(P均<0.05)。结论恒速泵注小剂量甲氧明能够在下肢止血带术中维持糖尿病患者血流动力学的稳定,抑制氧化应激及炎症因子的产生。

Objective To evaluate the effect of constant-speed pump infusion of methoxamine in the lower limb tourniquet surgery on hemodynamics, myocardial injury and oxidative stress in patients with diabetes mellitus. Methods Sixty diabetes mellitus patients who underwent knee replacement were randomly divided into the methoxamine group(n = 30) and control group(n = 30). In the methoxamine group, patients were injected with methoxamine [2μg/(kg·min)] intravenously after plane fixation, and those in the control group were injected with the same amount of normal saline. Serum cardiactroponin(cTnT), malondialdehyde(MDA), IL-6 and Apelin-13 levels were measured before(T0), 10 min(T1) and 30 min(T2) after releasing the tourniquet. The changes of T0-T2 heart rate(HR), mean arterial pressure(MAP) and electrocardiogram were observed, and adverse reactions were recorded. Results Compared with the control group, the HR and MAP from T0 to T2 were more stable, and the incidence of ST-T segment changes was significantly lower in the methoxamine group(all P < 0.05). After loosening the tourniquet at T1 and T2 time points, the serum levels of cTnT, MDA and IL-6 were up-regulated, whereas the serum levels of Apelin-13 were up-regulated in two groups. At T1 and T2 time points, the serum levels of cTnT, MDA and IL-6 in the methoxamine group were significantly lower, whereas that of Apelin-13 was significantly higher than those in the control group(all P < 0.05).Conclusion Constant-speed pump injection of low-dose methoxamine can maintain the hemodynamic stability and inhibit the production of oxidative stress and inflammatory factors in patients with diabetes mellitus during the lower limb tourniquet surgery.