中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
9期
1045-1047
,共3页
陆斌%张序忠%胡世特%郑圣舟%吴安生
陸斌%張序忠%鬍世特%鄭聖舟%吳安生
륙빈%장서충%호세특%정골주%오안생
右美托咪啶%再灌注损伤%四肢%呼吸窘迫综合征,成人
右美託咪啶%再灌註損傷%四肢%呼吸窘迫綜閤徵,成人
우미탁미정%재관주손상%사지%호흡군박종합정,성인
Dexmedetomidine%Reperfusion injury%Extremities%Respiratory distress syndrome,adult
目的 评价右美托咪定对肢体缺血再灌注致患者肺损伤的影响.方法 单侧下肢手术患者40例,性别不限,年龄18～60岁,体重指数20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,预计1h≤手术时间≤1.5h,采用随机数字表法,将其分为2组(n=20):对照组(C组)和右美托咪定组(D组).D组静脉输注右美托咪定1 μg/kg 10 min,随后以0.5 μg·kg-1 ·h-1的速率输注至术毕.C组静脉输注等容量生理盐水.于麻醉前即刻(T1)、应用止血带后60 min(T2)、松开止血带后30 min、2和6 h(T3-5)时采集桡动脉血样行血气分析,记录动脉血氧分压(PaO2)和二氧化碳分压(PaCO2),计算肺泡-动脉血氧分压差(A-aDO2)和呼吸指数(RI);采用ELISA法测定血浆IL-6、IL-8和TNF-α浓度;采用硫代巴比妥酸法测定血浆丙二醛(MDA)浓度,采用黄嘌呤氧化酶法测定血浆超氧化物歧化酶(SOD)活性.结果 与C组比较,D组T5时PaO2升高,A-aDO2和RI降低,T4.5时血浆IL-6和IL-8浓度降低,T3-5时血浆TNF-α、MDA和SOD水平降低(P＜0.05).结论 右美托咪定可减轻肢体缺血再灌注致患者肺损伤,与抑制炎性反应和脂质过氧化反应有关.
目的 評價右美託咪定對肢體缺血再灌註緻患者肺損傷的影響.方法 單側下肢手術患者40例,性彆不限,年齡18～60歲,體重指數20 ～ 25 kg/m2,ASA分級Ⅰ或Ⅱ級,預計1h≤手術時間≤1.5h,採用隨機數字錶法,將其分為2組(n=20):對照組(C組)和右美託咪定組(D組).D組靜脈輸註右美託咪定1 μg/kg 10 min,隨後以0.5 μg·kg-1 ·h-1的速率輸註至術畢.C組靜脈輸註等容量生理鹽水.于痳醉前即刻(T1)、應用止血帶後60 min(T2)、鬆開止血帶後30 min、2和6 h(T3-5)時採集橈動脈血樣行血氣分析,記錄動脈血氧分壓(PaO2)和二氧化碳分壓(PaCO2),計算肺泡-動脈血氧分壓差(A-aDO2)和呼吸指數(RI);採用ELISA法測定血漿IL-6、IL-8和TNF-α濃度;採用硫代巴比妥痠法測定血漿丙二醛(MDA)濃度,採用黃嘌呤氧化酶法測定血漿超氧化物歧化酶(SOD)活性.結果 與C組比較,D組T5時PaO2升高,A-aDO2和RI降低,T4.5時血漿IL-6和IL-8濃度降低,T3-5時血漿TNF-α、MDA和SOD水平降低(P＜0.05).結論 右美託咪定可減輕肢體缺血再灌註緻患者肺損傷,與抑製炎性反應和脂質過氧化反應有關.
목적 평개우미탁미정대지체결혈재관주치환자폐손상적영향.방법 단측하지수술환자40례,성별불한,년령18～60세,체중지수20 ～ 25 kg/m2,ASA분급Ⅰ혹Ⅱ급,예계1h≤수술시간≤1.5h,채용수궤수자표법,장기분위2조(n=20):대조조(C조)화우미탁미정조(D조).D조정맥수주우미탁미정1 μg/kg 10 min,수후이0.5 μg·kg-1 ·h-1적속솔수주지술필.C조정맥수주등용량생리염수.우마취전즉각(T1)、응용지혈대후60 min(T2)、송개지혈대후30 min、2화6 h(T3-5)시채집뇨동맥혈양행혈기분석,기록동맥혈양분압(PaO2)화이양화탄분압(PaCO2),계산폐포-동맥혈양분압차(A-aDO2)화호흡지수(RI);채용ELISA법측정혈장IL-6、IL-8화TNF-α농도;채용류대파비타산법측정혈장병이철(MDA)농도,채용황표령양화매법측정혈장초양화물기화매(SOD)활성.결과 여C조비교,D조T5시PaO2승고,A-aDO2화RI강저,T4.5시혈장IL-6화IL-8농도강저,T3-5시혈장TNF-α、MDA화SOD수평강저(P＜0.05).결론 우미탁미정가감경지체결혈재관주치환자폐손상,여억제염성반응화지질과양화반응유관.
Objective To evaluate the effect of dexmedetomidine on lung injury induced by extremity ischemia-reperfusion.Methods Forty patients,aged 18-60 yr,with body mass index of 20-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,with 1 h ≤ predicted duration of surgery ≤ 1.5 h,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and dexmedetomidine group (group D).In groupD,dexmedetomidine 1 (g/kg was infused intravenously for 10 min,followed by continuous infusion of dexmedetomidine at 0.5 μg· kg-1 · h-1 until the end of the surgery,while in group C the equal volume of normal saline was given instead.Immediately before induction of anesthesia (T1,baseline),at 60 min after tourniquet was inflated (T2) and at 30 min,2 h and 6 h after tourniquet release (T3-5),blood samples were collected from the radial artery for blood gas analysis and for measurement of the levels of plasma interleukin-6 (IL-6),IL-8,tumor necrosis factor-α (TNF-α),malondialdehyde (MDA) and superoxide dismutase (SOD),and arterial partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded.Alveolar-arterial oxygen difference (A-aDO2) and respiratory index (RI) were calculated.Results Compared with group C,PaO2 was significantly increased at T5,and A-aDO2 and RI at T5,the levels of plasma IL-6 and IL-8 were decreased at T4,5 and the levels of plasma TNF-α,MDA and SOD were decreased at T3-5 in group D.Conclusion Dexmedetomidine can attenuate lung injury induced by extremity ischemia/reperfusion via inhibiting inflammatory responses and lipid peroxidation.
