右美托咪定对高血糖冠心病患者围术期血糖变异性及血栓素A_2和前列环素平衡的影响  

The effect of dexmedetomidine on perioperative blood glucose variability and thromboxane A_2/epoprostenol balance in patients with high blood glucose and coronary heart disease

作　　者：沈华[1] 陈轶菁[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院麻醉科,上海市200437

出　　处：《临床麻醉学杂志》2012年第4期375-377,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨右美托咪定对高血糖冠心病患者围术期血糖变异性及血栓素A2(TXA2)和前列环素(PGI2)平衡的影响。方法择期行下肢骨科手术患者40例,年龄>65岁,ASAⅡ或Ⅲ级,符合WHO冠心病诊断标准,糖化血红蛋白(HbA1c)>6.5%。患者随机均分为两组,在麻醉诱导前至术毕分别泵注右美托咪定组(D组)和生理盐水组(C组)。两组患者均采用静注芬太尼3μg/kg、维库溴铵0.1mg/kg、丙泊酚1～2mg/kg麻醉诱导,BIS≤50并维持3min后行气管插管。分别于插管和拔管前后测定血糖值及血浆血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto-PGF1α)浓度,并计算血糖变异系数(GluCV)。结果插管和拔管前后两组TXB2和6-keto-PGF1α均显著升高(P<0.05);且D组TXB2明显低于C组(P<0.05),6-keto-PGF1α明显高于C组(P<0.05);C组TXB2/6-keto-PGF1α显著升高,且明显高于D组(P<0.05)。D组GluCV显著小于C组(P<0.05)。结论右美托咪定对全麻插管和手术创伤所诱发的应激反应有明显的抑制作用,能有效控制高血糖冠心病患者围术期血糖波动,改善TXA2和PGI2的平衡。Objective To investigate the effect of dexmedetomidine on perioperative blood glucose variability and thromboxane A2/epoprostenol（TXA2/PGI2） balance in patients with high blood glucose and coronary heart disease.Methods Forty elderly patients,diagnosed with coronary heart disease and glycated hemoglobin（HbA1c）〉6.5%,ASA Ⅱ or Ⅲ,scheduled for elective lower limb surgery,were randomly divided into two groups：group D（n=20） and group C（n=20）.Group D received dexmedetomidine infusion before anesthesia induction until the end of operation,while group C was infused with saline instead.Blood glucose,plasma concentration of TXB2 and 6-keto-PGF1α were assessed before and after intubation as well as after extubation,and glucose coefficient of variation（GluCV） was calculated.Results The concentrations of TXB2 and 6-keto-PGF1α were increased after intubation and extubation in both groups（P〈0.05）.The level of TXB2 was lower while 6-keto-PGF1α was higher in group D than those in group C（P〈0.05）.The ratio of TXB2 to 6-keto-PGF1α was markedly increased in group C and was significantly higher than that of group D（P〈0.05）.The GluCV of group D was significantly smaller than that of group C.Conclusion Dexmedetomidine can markedly suppress the stress response induced by endotracheal intubation and surgical stimuli,can effectively control the perioperative blood glucose fluctuation in patients with high blood glucose and coronary heart disease,and can improve the balance between TXA2 and PGI2.

关 键 词：右美托咪定 血糖变异性 6-酮-前列腺素F1Α 前列环素 血栓素A2 血栓素B2 

分 类 号：R614[医药卫生—麻醉学]