右美托咪定对老年高血压患者下肢缺血再灌注后心肌损伤的影响  

Effect of Dexmedetomidine on myocardial injury after lower extremity ischemia reperfusion in elderly hypertensive patients

作　　者：刘秀叶 王莉[1] 周长浩[1] 穆秀娥[1] 郭琼梅[1] LIU Xiuye;WANG Li;ZHOU Changhao;MU Xiu’e;GUO Qiongmei(Department of Anesthesiology,the First Hospital of Hebei Medical University,Hebei Province,Shijiazhuang050031,China)

机构地区：[1]河北医科大学第一医院麻醉科,河北石家庄050031

出　　处：《中国医药导报》2022年第4期107-110,123,共5页China Medical Herald

基　　金：河北省卫生健康委员会医学科学研究课题(20201157)。

摘　　要：目的探讨右美托咪定对老年高血压患者下肢缺血再灌注后心肌损伤的影响。方法选择2019年1月至2020年12月河北医科大学第一医院行膝关节置换术的老年高血压患者60例,采用随机数字表法分为右美托咪定组(D组,30例)和对照组(C组,30例)。D组于麻醉诱导后给予右美托咪定负荷量1μg/kg,维持量0.4μg/(kg·h)至手术结束前30 min;C组以同样的方法给予生理盐水。采集两组患者上止血带前(T_(0)),松止血带后20 min(T_(1))、2 h(T_(2))、12 h(T_(3))的静脉血,测定血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)],氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)],心肌损伤标志物[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]水平。结果两组T_(1)~T_(3)时血清TNF-α、IL-6、MDA水平高于T_(0)时,D组T_(1)~T_(3)时血清TNF-α、IL-6、MDA水平低于C组,差异有统计学意义(P<0.05)。两组T_(1)~T_(3)时血清SOD水平低于T_(0)时,D组T_(1)~T_(3)时血清SOD水平高于C组,差异有统计学意义(P<0.05)。两组T_(2)、T_(3)时血清CK-MB、cTnI浓度高于T_(0)时,D组T_(2)、T_(3)时血清CK-MB、cTnI浓度低于C组,差异有统计学意义(P<0.05)。结论右美托咪定可明显减轻老年高血压患者止血带相关的炎症反应及氧化应激反应,减轻下肢缺血再灌注后的心肌损伤。Objective To investigate the effect of Dexmedetomidine on myocardial injury after lower extremity ischemia reperfusion in elderly hypertension patients.Methods A total of 60 elderly hypertension patients who underwent knee replacement in the First Hospital of Hebei Medical University from January 2019 to December 2020 were selected,they were divided into Dexmedetomidine group(group D,30 cases)and control group(group C,30 cases)by random number table method.Group D was given Dexmedetomidine 1μg/kg after anesthesia induction,and maintained at 0.4μg/(kg·h)until 30 min before the end of surgery;group C was given normal saline in the same way.Venous blood was collected at before tourniquet(T_(0)),20 min(T_(1)),2 h(T_(2)),and 12 h(T_(3))after tourniquet loosening in two groups.The levels of serum inflammatory factors(tumor necrosis factor-α[TNF-α],interleukin-6[IL-6]),oxidative stress index(malondialdehyde[MDA],superoxide dismutase[SOD]),and myocardial injury markers(creatine kinase isoenzyme[CK-MB],troponin I[cTnI])were determined.Results The levels of TNF-α,IL-6,and MDA in two groups at T_(1)-T_(3) were higher than those at T_(0),and the levels of TNF-α,IL-6,and MDA in group D at T_(1)-T_(3) were lower than those in group C,and the differences were statistically significant(P<0.05).The levels of SOD at T_(1)-T_(3) in two groups were lower than those at T_(0),and the levels of SOD at T_(1)-T_(3) in group D were higher than those in group C,and the differences were statistically significant(P<0.05).The levels of CK-MB and cTnI at T_(2),T_(3) in two groups were higher than those at T_(0),and the levels of CK-MB and cTnI in group D at T_(2),T_(3) were lower than those in group C,and the differences were statistically significant(P<0.05).Conclusion Dexmedetomidine can significantly reduce tourniquet related inflammation and oxidative stress in elderly hypertension patients and reduce myocardial injury after lower extremity ischemia reperfusion.

关 键 词：右美托咪定 老年高血压 止血带 缺血再灌注心肌损伤 炎症反应 氧化应激 

分 类 号：R614[医药卫生—麻醉学]