摘要
目的观察右美托咪定对糖尿病患者行下肢止血带手术炎症反应、胰岛素抵抗及心肌损伤的影响。方法选择择期全身麻醉下接受骨科下肢手术需用止血带的2型糖尿病患者60例,按随机数字表法分为右美托咪定组(观察组)和对照组,每组30例。麻醉诱导后观察组给予初始剂量1μg/kg右美托咪定(给药时间15min),之后以0.5μg·kg^(-1)·h^(-1)的速率维持至术毕;对照组以同样的方法给予等容量生理盐水。分别于上止血带前(T0)、松止血带后15min(T1)、松止血带后1h(T2)和松止血带后12h(T3)4个时间点抽取颈内静脉血测定炎症因子肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和血清白细胞介素6(interleukin-6,IL-6)浓度,血糖及胰岛素水平并计算胰岛素敏感指数(insulin sensitive index,ISI),心肌损伤标志物肌钙蛋白I(cardiac troponin I,cTnI)和磷酸肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)浓度。结果 2组TNF-α、血糖、胰岛素水平呈先升高再降低的趋势,IL-6、cTnI、CKMB浓度呈逐渐升高趋势,观察组各指标低于对照组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。2组ISI均呈降低趋势,观察组高于对照组,其组间、时点间差异有统计学意义(P<0.05),组间·时点间交互作用差异无统计学意义(P>0.05)。结论右美托咪定可明显减轻糖尿病患者行下肢止血带手术的炎症反应,降低术中血糖,改善胰岛素抵抗,减轻缺血再灌注心肌损伤。
Objective To investigate the effects of dexmedetomidine on inflammatory response,insulin resistance and myocardial injury caused by lower limb tourniquet surgery in diabetic patients.Methods According to random data table method,a total of 60 diabetic patients who were accepted lower limb orthopedic surgery were divided into observation group and the control group,30 cases in each group.In observation group,dexmedetomidine 1μg/kg（initial dose）was given（15 min）after induction of anesthesia,followed by continuous infusion at0.5μg·kg-1·h-1,until the end of operation.The equal volume of normal saline was given instead of dexmedetomidine in the control group.Before the tourniquet（T0）,after loose tourniquet 15 min（T1）,after loose tourniquet 1 h（T2）and after loose tourniquet 12 h（T3）,blood samples were collected for determination of tumor necrosis factorα（TNF-α）,interleukin 6（IL-6）,blood glucose and insulin,cardiac troponin I（cTnI）and phosphoric acid creatine kinase isoenzyme（CK-MB）concentrations.The insulin sensitivity index（ISI）was obtained.Results The concentration of TNF-α、blood glucose and insulin in the two groups were firstly increased and then decreased,while the levels of IL-6,cTnI and CK-MB were gradually increased,all indexes of the observation group were lower than those of the control group,there were statistically significant differences between groups,time points and their interactions（P〈0.05）.The SIS were gradually decreased in the two groups,and the observation group was higher than the control group,there were statistically significant differences between groups and time points（P〈0.05）,while there was no significant difference between their interactions（P〉0.05）.Conclusion Dexmedetomidine can reduce the inflammatory response,alleviate myocardial injury caused by lower limb tourniquet surgery,thus reducing blood glucose and insulin resistance in diabetic patients.
作者
王莉
刘秀叶
郭琼梅
孙媛
WANG Li;LIU Xiu-ye;GUO Qiong-mei;SUN Yuan(Department of Anesthesiology,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)
出处
《河北医科大学学报》
CAS
2018年第12期1438-1441,1446,共5页
Journal of Hebei Medical University
基金
河北省医学科学研究重点课题(20160698)
关键词
糖尿病
2型
右美托咪定
止血带
diabetes mellitus,type 2
dexmedetomidine
tourniquets
