氟比洛芬酯镇痛预处理对糖尿病患者围术期氧化应激及Apelin的影响

目的 探讨氟比洛芬酯镇痛预处理对合并2型糖尿病患者围术期氧化应激及Apelin的影响。方法 选取择期接受脊柱手术的患者100例,将其中的65例糖尿病患者随机分为预处理组（32例）及空白对照组（33例）,前者于麻醉诱导前10 min给予氟比洛芬酯注射液1.0 mg/kg预处理,后者行常规麻醉诱导,不予预处理。将35例非糖尿病患者作为正常对照组,不予预处理。观察术前（T0）、术中1 h（T1）、术后1 h（T2）各时间点的血清Apelin-13、血管紧张素Ⅱ（AngⅡ）、丙二醛（MDA）、IL-6和血糖水平变化,同时比较手术前后1 d白细胞计数（WBC）及中性粒细胞百分比（NEUT%）。结果 3组患者AngⅡ、MDA、IL-6均呈现先上升（T0~T1）后回落（T1~T2）的趋势,且上述指标在T2均高于T0;而Apelin-13水平则先下降后回升,在T2低于T0（P均< 0.05）。与正常对照组比较,同一时间点预处理组及空白对照组各项指标均升高,血糖波动增大,且术后WBC、NEUT%升高;与空白对照组比较,预处理组Apelin-13水平升高,IL-6、MDA、AngⅡ水平下降,术后WBC、NEUT%及血糖波动幅度均减小（P均< 0.05）。结论 氟比洛芬酯预处理可调节血清Apelin-13水平,在一定程度上降低炎症因子及氧化应激指标水平,抑制术后WBC和NEUT%的升高,改善2型糖尿病患者围术期氧化应激和血糖波动。

Effect of flurbiprofen axetil pretreatment on perioperative oxidative stress and Apelin in patients with diabetes mellitus

Objective To investigate the effect of flurbiprofen axetil pretreatment on perioperative oxidative stress and Apelin in patients with type 2 diabetes mellitus. Methods A total of 100 patients scheduled to undergo spinal surgery were recruited. Among them, 65 patients with diabetes mellitus were randomly divided into the pretreatment group （n = 32） and blank control group （n = 33）. In the pretreatment group, patients were pretreated with flurbiprofen axetil injection at a dose of 1.0 mg/kg at 10 min before anesthesia induction, and those in the blank control group received routine anesthesia without pretreatment. Non-diabetic patients were assigned into the normal control group （n = 35）, who were not given with pretreatment. The changes of the serum levels of Apelin-13, Ang Ⅱ, MDA, IL-6, blood glucose were observed at preoperative （T0）, intraoperative 1 h （T1） and postoperative 1 h （T2） time points, respectively. Meantime, the white blood cell count （WBC）and neutrophil percentage（NEUT%） were compared before and 1 d after operation. Results The serum levels of Ang Ⅱ, MDA and IL-6 in all three groups showed a trend of initial increase （T0-T1） and then decline （T1-T2）, and the levels at T2 were higher than those at T0. However, the serum levels of Apelin-13 were initially decreased and then increased, and the levels at T2 were significantly lower compared with those at T0 （all P < 0.05）. Compared with the normal control group, all serum indexes at the same time point were increased, blood glucose fluctuation was enlarged, and postoperative WBC and NEUT% were increased in the pretreatment and blank control groups. Compared with the blank control group, the serum level of Apelin-13 was significantly up-regulated, those of IL-6, MDA and Ang Ⅱ were significantly decreased, and postoperative WBC, NEUT% and blood glucose fluctuation were significantly decreased in the pretreatment group （all P < 0.05）. Conclusion Flurbiprofen axetil preconditioning can regulate the serum level of Apelin-13, lower inflammatory factors and oxidative stress indexes to certain extent, inhibit the increase of WBC and NEUT% after operation, and mitigate perioperative oxidative stress and blood glucose fluctuation in diabetic patients.