缺血预适应联合右美托咪定对老年膝关节置换术患者远隔器官功能的影响  

Effect of ischemic preconditioning combined with dexmedetomidine on distal organ function in elderly patients undergoing knee arthroplasty

作　　者：石伯生 黄涌 邓宏平 SHI Bosheng;HUANG Yong;DENG Hongping(Department of Anesthesiology,Nantong Affiliated Hospital of Nanjing University of Chinese Medicine,Nantong Hospital of Traditional Chinese Medicine,Nantong,Jiangsu 226001,China)

机构地区：[1]南京中医药大学南通附属医院(南通市中医院)麻醉科,江苏南通226001

出　　处：《徐州医科大学学报》2023年第10期720-725,共6页Journal of Xuzhou Medical University

基　　金：江苏省卫生计生委医学科研课题面上项目(H2018050)。

摘　　要：目的评估缺血预适应联合右美托咪定对老年单侧膝关节置换术患者下肢缺血再灌注后远隔器官功能和氧化应激的影响。方法纳入2018年5月—2021年4月南通市中医院行单侧膝关节置换术的老年患者。按随机数字表法分为缺血预适应联合右美托咪定组(I+D组)、缺血预适应组(I组)、右美托咪定组(D组)和对照组(C组),每组各25例。于止血带使用前(T0)、撤止血带15 min后(T1)、出室后6 h(T2)抽取动脉血。测定各组氧化应激反应相关指标水平,包括丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)。同时测定T0、T1、T2时反映器官功能的相关指标,包括肌酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、血尿素氮(BUN)。结果I+D组、I组、D组患者T1时点MDA、TNF-α、IL-1、IL-6、ALT、AST均显著低于C组患者,差异有统计学意义(P<0.05)。I+D组、I组、D组患者T2时点MDA、ALT、AST显著低于C组患者,差异有统计学意义(P<0.05)。结论老年单侧膝关节置换术患者缺血预适应和右美托咪定均可对抗下肢缺血再灌注所致的氧化应激反应和肝脏损伤,但二者联合应用保护效果并未增强。Objective To evaluate the effect of ischemic preconditioning combined with dexmedetomidine on distal organ function and oxidative stress after lower extremity ischemia-reperfusion in elderly patients undergoing unilateral knee arthroplasty.Methods Elderly patients who underwent unilateral knee replacement in Nantong Hospital of Traditional Chinese Medicine from May 2018 to April 2021 were included.According to the random number table method,they were divided into four groups(n=25):an ischemic preconditioning combined dexmedetomidine group(group I+D),an ischemic preconditioning group(group I),a dexmedetomidine group(group D)and a control group(group C).Then,arterial blood samples were collected before the use of tourniquet(T0),15 min after tourniquet removal(T1)and 6 h after discharge from the room(T2).The levels of oxidative stress response related indicators were measured,inlcuding malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),and interleukin-6(IL-6).Meanwhile,organ function related indexes at T0,T1 and T2 were determined,including creatine kinase isoenzyme(CKMB),lactate dehydrogenase(LDH),alanine transaminase(ALT),aspartate transferase(AST),serum creatinine(Scr),and blood urea nitrogen(BUN).Results Group I+D,group I,and group D produced significantly lower levels of MDA,TNF-α,IL-1,IL-6,ALT and AST than group C at T1(P<0.05).The levels of MDA,ALT and AST were significantly reduced in groups I+D,I and D at T2,compared with those in group C(P<0.05).Conclusions In elderly patients undergoing unilateral knee arthroplasty,both ischemia-preconditioning and dexmedetomidine can function against oxidative stress and liver injury induced by lower extremity ischemia-reperfusion,but their combined protective effect is not enhanced.

关 键 词：缺血预适应 右美托咪定 膝关节置换术 缺血再灌注损伤 远隔器官 氧化应激 

分 类 号：R614.2[医药卫生—麻醉学]