右美托咪定对骨科下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响  

The effect of dexmedetomidine on tourniquet-induecd ischemia-reperfusion injury in patients undergoing lower extremity operations

作　　者：阮孝国[1] 刘贺[1] 孟凡民[1] 张加强[1] 

机构地区：[1]郑州大学人民医院麻醉科,郑州市450003

出　　处：《临床麻醉学杂志》2015年第7期668-670,共3页Journal of Clinical Anesthesiology

摘　　要：目的 探讨右美托咪定对骨科下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响。方法 择期拟行关节镜下膝关节韧带修复术患者40例,年龄18-64岁,体重44-85kg,ASA I或Ⅱ级。采用随机数字表法,将患者随机均分为右美托咪定组（D组）和对照组（C组）,均采用脊椎-硬膜外联合阻滞,腰麻药物为0.5%布比卡因12-15mg,于上止血带前20min时D组静脉输注右美托咪定负荷量（输注剂量0.5μg/kg,输注时间10min）,维持剂量0.5μg·kg-1·h-1直至手术结束,C组输注等容量生理盐水。于入室后（T0）、松止血带即刻（T1）、30 min（T2）时抽取术侧静脉血样,测定血浆丙二醛（MDA）和肿瘤坏死因子α（TNF-α）浓度。记录术中恶心呕吐、心动过缓等并发症的发生情况。结果 与T0时比较,T1、T2时两组血浆MDA和TNF-α浓度明显升高（P〈0.05）;与C组比较,T1、T2时D组血浆MDA及TNF-α浓度明显降低（P〈0.05）。结论 右美托咪定似可减轻止血带诱发下肢缺血-再灌注损伤。Objective To evaluatethe effects of dexmedetomidine on a tourniquet-induced lower extremity ischemia reperfusion injury in patients undergoing orthopedic operation.Methods Forty ASA Ⅰ orⅡ patients,aged 18-64 years,weighing 44-85 kg,scheduled for elective arthroscopic knee ligament repair,were randomized into two groups（n=20each）：dexmedetomidine group（group D）and control group（group C）.In both groups,spinal anesthesia was performed with 0.5% ropivacaine 12-15 mg.Group D was administered with a bolus dexmedetomidine infusion at a dose of 0.5μg/kg in 10 minutes before the use of the tourniquet and dexmedetomidine was infused continuously at 0.5μg·kg-1·h-1 until the end of the operation.Group C received a saline infusion of the same amount and for the same period of time.Blood samples were taken after admission to the operating room（T0）,and at 1、30minutes after tourniquet release（T1,T2）.The plasma concentrations of MDA and TNF-αwere analyzed.The changing rate of MDA and TNF-αconcentrations was calculated.The complications such as nausea and vomiting,bradycardia were recorded.Results The plasma concentrations of MDA and TNF-αat T1 and T2 were significantly higherthan those at T0 in both groups（P〈0.05）.The plasma concentrations of MDA and TNF-αin group D were significantly lower than in group C（P〈0.05）.Conclusion Dexmedetomidine can reduce the lower extremity ischemia-reperfusion injury caused by tourniquet in patients undergoing lower extremity surgery.

关 键 词：右美托咪定 缺血-再灌注损伤 下肢 止血带 

分 类 号：R614[医药卫生—麻醉学]