右美托咪定对老年胃癌手术患者红细胞醛糖还原酶和炎症反应的影响  

Effects of dexmedetomidine on erythrocyte aldose reductase and inflammatory response in elderly patients undergoing gastric cancer surgery

作　　者：张晓坤[1] 宿明艳[1] 王喆妍[1] 顾伟[1] ZHANG Xiaokun;SU Mingyan;WANG Zheyan;GU Wei(Department of Anesthesiology,Drum Tower Hospital Affiliated To Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《临床麻醉学杂志》2020年第3期213-216,共4页Journal of Clinical Anesthesiology

基　　金：南京市卫生局项目(YKK13076)。

摘　　要：目的观察右美托咪定对老年患者胃癌手术围术期红细胞醛糖还原酶(AR)的作用,并探讨其对机体炎症反应和氧化应激水平的影响。方法老年胃癌手术患者60例,男42例,女18例,年龄65~78岁,BMI 17~26 kg/m^2,ASAⅠ-Ⅲ级。随机分为右美托咪定组(DEX组)和对照组(C组),每组30例。DEX组术前10 min静脉泵注右美托咪定0.5μg/kg,术中维持速率0.3μg·kg^-1·h^-1至关腹,C组术前和术中静脉泵注等剂量的生理盐水。分别于麻醉诱导前(T0)、手术开始1 h(T1)、术后1 h(T2)、术后1 d晨(T3)和术后2 d晨(T4)抽取肘静脉血,测定AR活性和总抗氧化能力(T-AOC),同时检测C-反应蛋白(CRP)、血清肿瘤坏死因子(TNF-α)和白细胞介素-8(IL-8)。结果与T0时比较,T3时两组AR活性明显增强(P<0.05),T-AOC明显下降(P<0.05)。T3时DEX组AR活性明显弱于C组(P<0.05),T-AOC明显高于C组(P<0.05)。与T0时比较,T1-T4时两组CRP和TNF-α明显升高(P<0.05),T1-T4时C组IL-8明显升高(P<0.05),T3-T4时DEX组IL-8明显升高(P<0.05)。T2-T3时DEX组CPR和TNF-α明显低于C组(P<0.05),T3时DEX组IL-8明显低于C组(P<0.05)。结论右美托咪定可以减弱老年胃癌手术患者术后醛糖还原酶的活性,减轻围术期炎症反应和氧化应激程度。Objective To study the effects of dexmedetomidine on the activities of aldose reductase(AR) in erythrocytes,inflammatory response and oxidative stress in patients undergoing gastric cancer surgery. Methods Sixty elderly patients, 42 males and 18 females,aged 65-78 years,BMI 17-26 kg/m^2, ASA physical statusⅠ-Ⅲ, scheduled for gastric cancer surgery were randomly divided into DEX group(group DEX) and control group(group C), 30 cases in each group. The patients in group DEX were intravenously infused 0.5 μg/kg dexmedetomidine 10 minutes before operation and perioperatively followed by an infusion at a rate of 0.3 μg·kg^-1·h^-1 until the abdomen were closed. Group C were infused the same amount of normal saline. Venous blood samples were collected for the measurement of AR activity in erythrocytes and the serum levels of total antioxidant capacity(T-AOC), tumor necrosis factor α(TNF-α), interleukin 8(IL-8), c-reactive protein(CRP) before induction(T0),1 h following the incision(T1),1 h(T2), 1st day(T3) and 2nd day(T4) of postoperation. Results Compared with T0, the activity of AR was enhanced markedly(P < 0.05),and T-AOC decreased significantly in both groups at T3(P < 0.05), while the activity of AR in group DEX at T3 was significantly weaker than that in group C(P < 0.05). T-AOC in group DEX at T3 was significantly higher than that in group C(P < 0.05). Compared with T0, TNF-α and CRP in the two groups were significantly increased at time points from T1-T4(P<0.05). And IL-8 in group C were significantly increased at time points from T1-T4(P<0.05), IL-8 in group DEX were significantly increased at time points from T3 and T4(P<0.05). TNF-α and CRP in group DEX were significantly lower than those in group C at T2 and T3(P<0.05). IL-8 in group DEX was significantly lower than that in group C at T3(P<0.05). Conclusion Dexmedetomidine could reduce the activity of AR and alleviate perioperative inflammatory response and oxidative stress in elderly patients undergoing gastric cancer surgery.

关 键 词：右美托咪定 红细胞 肿瘤坏死因子Α 白细胞介素-8 C反应蛋白 氧化应激 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]