中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
6期
499-503
,共5页
右美托咪啶%止血带%再灌注损伤%氧化应激%炎性因子
右美託咪啶%止血帶%再灌註損傷%氧化應激%炎性因子
우미탁미정%지혈대%재관주손상%양화응격%염성인자
Dexmedetomidine%Tourniquets%Reperfusion injury%Oxidative stress%Inflammatory cytokines
目的 观察右美托咪啶(DEX)对骨科止血带所致缺血-再灌注损伤氧化应激和炎性因子的影响.方法 回顾性分析80例择期行骨科下肢手术的患者资料,根据有无使用DEX分为对照组和DEX组(n=40).所有患者均采用两点穿刺腰硬联合麻醉,完成穿刺后,DEX组静脉在10 min内给予DEX负荷剂量1μg/kg,后改为维持剂量0.5 μg/kg·h至手术结束;对照组给予等速度、等容量的生理盐水.分别测定并比较T1(上止血带前)、T2(松止血带后10 min)、T3(松止血带后30 min)、T4(松止血带后60 min)4个时间点两组患者心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2)及血清的丙二醇(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)和白介素-8(IL-8)的含量.结果 各个时间点的HR、MAP、SPO2两组间比较,差异均无统计学意义(P＞ 0.05).同一组内的HR、MAP、SPO2不同时间点间比较,差异均无统计学意义(P＞0.05).在T1时间点,两组患者血清MDA、SOD、TNF-α和IL-8含量比较差异均无统计学意义(P＞0.05).与对照组相比,DEX组患者在T2、T3、T4时间点的血清MDA、TNF-α和IL-8含量显著降低,SOD含量显著升高,差异均有统计学意义(P＜0.05).止血带处理后,与T1时间点相比,T2、T3、T4时间点两组患者血清MDA、TNF-α和IL-8含量显著升高,SOD含量显著降低,差异均有统计学意义(P＜0.05).结论 DEX可以明显降低骨科止血带所致缺血-再灌注损伤引起的氧化应激和炎性因子水平.
目的 觀察右美託咪啶(DEX)對骨科止血帶所緻缺血-再灌註損傷氧化應激和炎性因子的影響.方法 迴顧性分析80例擇期行骨科下肢手術的患者資料,根據有無使用DEX分為對照組和DEX組(n=40).所有患者均採用兩點穿刺腰硬聯閤痳醉,完成穿刺後,DEX組靜脈在10 min內給予DEX負荷劑量1μg/kg,後改為維持劑量0.5 μg/kg·h至手術結束;對照組給予等速度、等容量的生理鹽水.分彆測定併比較T1(上止血帶前)、T2(鬆止血帶後10 min)、T3(鬆止血帶後30 min)、T4(鬆止血帶後60 min)4箇時間點兩組患者心率(HR)、平均動脈壓(MAP)、血氧飽和度(SPO2)及血清的丙二醇(MDA)、超氧化物歧化酶(SOD)、腫瘤壞死因子-α(TNF-α)和白介素-8(IL-8)的含量.結果 各箇時間點的HR、MAP、SPO2兩組間比較,差異均無統計學意義(P＞ 0.05).同一組內的HR、MAP、SPO2不同時間點間比較,差異均無統計學意義(P＞0.05).在T1時間點,兩組患者血清MDA、SOD、TNF-α和IL-8含量比較差異均無統計學意義(P＞0.05).與對照組相比,DEX組患者在T2、T3、T4時間點的血清MDA、TNF-α和IL-8含量顯著降低,SOD含量顯著升高,差異均有統計學意義(P＜0.05).止血帶處理後,與T1時間點相比,T2、T3、T4時間點兩組患者血清MDA、TNF-α和IL-8含量顯著升高,SOD含量顯著降低,差異均有統計學意義(P＜0.05).結論 DEX可以明顯降低骨科止血帶所緻缺血-再灌註損傷引起的氧化應激和炎性因子水平.
목적 관찰우미탁미정(DEX)대골과지혈대소치결혈-재관주손상양화응격화염성인자적영향.방법 회고성분석80례택기행골과하지수술적환자자료,근거유무사용DEX분위대조조화DEX조(n=40).소유환자균채용량점천자요경연합마취,완성천자후,DEX조정맥재10 min내급여DEX부하제량1μg/kg,후개위유지제량0.5 μg/kg·h지수술결속;대조조급여등속도、등용량적생리염수.분별측정병비교T1(상지혈대전)、T2(송지혈대후10 min)、T3(송지혈대후30 min)、T4(송지혈대후60 min)4개시간점량조환자심솔(HR)、평균동맥압(MAP)、혈양포화도(SPO2)급혈청적병이순(MDA)、초양화물기화매(SOD)、종류배사인자-α(TNF-α)화백개소-8(IL-8)적함량.결과 각개시간점적HR、MAP、SPO2량조간비교,차이균무통계학의의(P＞ 0.05).동일조내적HR、MAP、SPO2불동시간점간비교,차이균무통계학의의(P＞0.05).재T1시간점,량조환자혈청MDA、SOD、TNF-α화IL-8함량비교차이균무통계학의의(P＞0.05).여대조조상비,DEX조환자재T2、T3、T4시간점적혈청MDA、TNF-α화IL-8함량현저강저,SOD함량현저승고,차이균유통계학의의(P＜0.05).지혈대처리후,여T1시간점상비,T2、T3、T4시간점량조환자혈청MDA、TNF-α화IL-8함량현저승고,SOD함량현저강저,차이균유통계학의의(P＜0.05).결론 DEX가이명현강저골과지혈대소치결혈-재관주손상인기적양화응격화염성인자수평.
Objective To investigate the effects of dexmedetomidine (DEX) on oxidative stress and inflammatory cytokines caused by tourniquet-induced ischemia-reperfusion injury at limbs.Methods Eighty patients who had been scheduled for lower limb operation with tourniquet were assigned equally by sequence number to use or not use DEX (DEX or control group,n =40).Combined spinal-epidural anesthesia was performed in both groups.In the DEX group,DEX intravenous infusion was started immediately after the femoral vein cannulated at a dose of 1 μg/kg for 10 minutes,followed by 0.5 μg/kg · h until the end of operation,whereas the control group received an equivalent volume of 0.9％ saline.At 10 min before tourniquet inflation (T1),10 min (T2),30 min (T3) and 60 min (T4) after tourniquet release,femoral venous blood samples were obtained to measure heart rate (HR),mean arterial pressure (MAP),saturation of pulse oximetry (SPO2),serum malondialdehyde (MDA),serum superoxide dismutase (SOD),serum tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) levels in both groups.Results There were no significant differences in HR,MAP or SPO2 at all time points between the 2 groups (P ＞ 0.05).There were no significant differences in HR,MAP or SPO2 at all time points within either group (P ＞ 0.05).There were no significant differences in serum MDA,SOD,TNF-α and IL-8 levels at T1 between the 2 groups (P＞ 0.05).The serum MDA,TNF-α and IL-8 levels were significantly lower and the serum SOD level significantly higher in the DEX group than in the control group at T2,T3 and T4,respectively (P ＜0.05).In both groups,the serum MDA,TNF-α and IL-8 levels were significantly higher and the serum SOD level significantly lower at T2,T3 and T4 than at T1,respectively (P ＜ 0.05).Conclusion Dexmedetomidine can reduce the oxidative stress and inflammatory cytokine level which are caused by tourniquet-induced ischemia-reperfusion injury.
