右美托咪定对下肢手术患者止血带诱发肢体缺血-再灌注损伤的影响  

Effect of Dexmedetomidine on the Patients with Lower Limb Surgery Tourniquet Induced Limb Ischemia-reperfusion Injury

作　　者：叶贵光 梁家新 莫振科 罗乔木 陈勇 

机构地区：[1]玉林市中西医结合骨科医院麻醉科,广西玉林537000

出　　处：《现代生物医学进展》2017年第28期5578-5581,5547,共5页Progress in Modern Biomedicine

摘　　要：目的:探讨右美托咪定对下肢手术患者因止血带诱发肢体缺血-再灌注损伤的影响。方法:选取2015年1月-2016年5月我院行下肢手术治疗的患者90例,按照数字随机法分为观察组及对照组,每组各45例。两组均给予蛛网膜下腔阻滞联合硬膜外麻醉,观察组在穿刺成功15 min内静脉输注1μg/kg的右美托咪定,维持剂量0.5μg/kg·h直至手术结束,对照组患者则给予同等剂量的生理盐水。对比两组止血带前(T0)、止血带充气30 min(T1)、止血带充气1 h(T2)、止血带释放后30 min(T3)、止血带释放后1 h(T4)时的超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、平均动脉压(MAP)、心率(HR)水平以及不良反应发生情况。结果:T3、T4时点观察组SOD水平显著高于对照组,MDA水平显著低于对照组(P<0.05)。T1、T2、T3、T4时点观察组TNF-α水平显著低于对照组,T4时点IL-6水平也显著低于对照组(P<0.05)。T1、T2时点观察组MAP、HR水平均显著低于对照组(P<0.05)。观察组术中止血带疼痛、高血压发生率均显著低于对照组(P<0.05)。结论:右美托咪定可显著抑制下肢手术患者止血带诱发氧化应激反应以及炎症反应,进而降低肢体缺血-再灌注损伤,具有较好的安全性。Objective： To study the application of dexmedetomidine on the patients with lower limb surgery and the effect of tourniquet induced limb ischemia-reperfusion injury. Methods： 90 patients with lower limb surgery who were treated in our hospital from January 2015 to May 2016 were selected,they were divided into the observation group and the control group according to the random number table method, each group of 45 cases. Two groups were given subarachnoid block combined with epidural anesthesia, the observation group was intravenous infusion of 1 μg/kg dexmedetomidine at punctured success within 15 min, the maintenance dose was 0.5 p,g/kg-h until the end of surgery, the control group was given the same dose of normal saline. The superoxide dismutase（SOD）, malondialdehyde（MDA）, tumor necrosis factor-α（TNF-α）and interleukin-6（IL-6）, mean arterial pressure（MAP）, heart rate（HR）level and the occurrence conditions of adverse reactions were compared between the two groups at before the tourniquet（T0）, tourniquet inflated 30 rain （T1）, tourniquet inflated lh （T2）,30min after the release of tourniquet （T3） and lh after the release of tourniquet （T4）. Results： The SOD level of observation group was significantly higher than that in control group, and the level of MDA was significantly lower than that in control group at T3, T4 time point （P 〈 0.05）. The level of TNF-α was significantly lower than that in control group at T1, T2, T3, T4 time point, and the IL-6 level of observation group was significantly lower than that in control group at T4 time point （P 〈 0.05）. The MAP, HR level of observation group were significantly lower than those in control group at T1, T2 time point （P 〈 0.05）; The intraoperative tourniquet pain and hypertension incidence of observation group were significantly lower than those in control group（P〈0. 05）, Conclusion： Dexrnedetomidine can significantly inhibit the patients with lower limb surgery tourniquet induced oxida

关 键 词：右美托咪定 止血带 缺血一再灌注 炎症因子 不良反应 

分 类 号：I14[文学—世界文学]