盐酸右美托咪定预处理对肠梗阻手术患者缺血再灌注后炎症因子的影响  

Effect of dexmedetomidine hydrochloride preconditioning on inflammatory factors in patients with intestinal obstruction after ischemia-reperfusion

作　　者：钱幸尔 戴晓薇 郑旻[1] 郑君刚[1] Qian Xing’er;Dai Xiaowei;Zheng Min;Zheng Jungang(Department of Anesthesiology, the First Hospital of Ningbo, Ningbo 315000, China)

机构地区：[1]宁波市第一医院麻醉科

出　　处：《北京医学》2019年第8期705-707,711,共4页Beijing Medical Journal

摘　　要：目的探讨盐酸右美托咪定在肠缺血期应用于肠梗阻手术患者对缺血再灌注损伤的控制效果。方法选取2016年1月10日至7月10日在宁波市第一医院接受手术治疗的肠梗阻患者48例,采用随机数字表法分为两组,A组在肠缺血期采用常规治疗,B组采用盐酸右美托咪定干预,比较肠缺血期和再灌注期外周血检测相关炎性因子水平、血浆肠型脂肪酸结合蛋白(intestinal fatty acid binding protein, I-FABP)和D-乳酸水平,比较干预处理0 h、3 h、6 h和24 h时血超氧化物歧化酶(superoxide dismutase, SOD)和二胺氧化酶(diamine oxidase, DAO)活性,评价术后7 d胃肠功能。结果两组再灌注期的IL-6、IL-10、TNF-α及IL-1β的含量均显著高于肠缺血期,其中B组再灌注期的各项炎性因子含量显著低于A组,差异均有统计学意义(P <0.05);B组干预后3 h、6 h及24 h的SOD和DAO活性显著高于A组,差异有统计学意义(P <0.05);B组术后7 d的胃肠功能评分为(0.6±0.2)分,显著高于A组的(0.2±0.1)分,差异有统计学意义(P <0.05);B组再灌注期血中的I-FABP和D-乳酸浓度[(510.1±75.0)ng/ml,(1.3±0.3)mg/ml]均显著低于A组[(662.3±73.1)ng/ml,(1.9±0.5)mg/ml],差异均有统计学意义(P <0.05)。结论盐酸右美托咪定应用于肠梗阻患者肠缺血期能有效控制SOD、DAO、I-FABP、D-乳酸以及各项炎性因子浓度,有助于减轻缺血再灌注损伤,值得临床推广。Objective To study the effect of dexmedetomidine hydrochloride on intestinal ischemia-reperfusion injury in patients undergoing intestinal obstruction. Methods From January 10 th, 2016 to July 10 th, 2016, 48 patients with intestinal obstruction underwent surgical treatment in The First Hospital of Ningbo were selected, who were divided into two groups by random number table method. Group A received routine treatment during intestinal ischemia, and group B received dexmedetomidine hydrochloride intervention. Peripheral blood samples were taken to detect the levels of inflammatory factors, plasma intestinal fatty acid binding protein(I-FABP) and D-lactic acid during intestinal ischemia and reperfusion, respectively,and 0 h, 3 h, 6 h and 24 h after intervention. Superoxide dismutase(SOD) and diamine oxidase(DAO) activities were measured in 24 h blood, and gastrointestinal function was evaluated 7 days after operation. Resluts The levels of IL-6, IL-10,TNF-α and IL-1βin the reperfusion period of the two groups were significantly higher than those in the intestinal ischemia period. The levels of inflammatory factors in group B during the reperfusion period were significantly lower than those in group A(P < 0.05). SOD and DAO activities in group B at 3, 6 and 24 h after intervention were significantly higher than those in group A(P < 0.05). The gastrointestinal function score of group B was(0.6 ± 0.2) 7 days after operation, which was significantly higher than that of group A(0.2 ± 0.1, P < 0.05). The blood concentration of I-FABP and D-lactic acid [(510.1±75.0)ng/ml,(1.3±0.3)mg/ml] in group B during reperfusion was significantly lower than that of group A [(662.3±73.1)ng/ml,(1.9±0.5)mg/ml, P < 0.05]. Conclusions Dexmedetomidine hydrochloride can effectively control the concentration of SOD, DAO, IFABP, D-lactic acid and various inflammatory factors during intestinal ischemia in patients with intestinal obstruction, which is helpful to alleviate ischemia-reperfusion injury and worthy of clinical promotion.

关 键 词：盐酸右美托咪定 肠缺血期 预处理 肠梗阻 缺血再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]