右美托咪定对减轻下肢手术患者止血带诱发肢体缺血—再灌注损伤的效果

目的探讨右美托咪定对减轻骨科下肢手术患者止血带导致缺血-再灌注损伤的效果。方法将该院骨科病房收治的62例需行下肢手术的患者按照随机数字表法分为右美托咪定组(n=24)、咪达唑仑组(n=23)及对照组(n=15)。所有患者均采用蛛网膜下腔阻滞联合硬膜外麻醉,右美托咪定组于穿刺后给予,负荷量1μg/kg,维持量0.5μg/(kg·h);咪达唑仑组于穿刺后给予,负荷量0.06mg/kg,维持量0.05μg/(kg·h)。对照组给予等量生理盐水。于使用止血带前(T0),松开止血带时(T1),松开止血带后30min(T2)时,采用酶联免疫吸附法(ELISA)检测血清羟自由基(OH)、超氧阴离子(O_2~-)、过氧化氢(H_2O_2)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平。结果 3组患者血清各氧化应激相关指标在T0时差异无统计学意义(P0.05),右美托咪定组患者血清OH、O_2~-、H_2O_2、MDA水平在T1时低于咪达唑仑组和对照组,血清SOD水平在T2时高于咪达唑仑组和对照组(P0.05);右美托咪定组患者血清O_2~-、H_2O_2水平在T2时仍低于咪达唑仑组和对照组,SOD仍高于咪达唑仑组和对照组(P0.05);与T0时相比,3组患者血清OH、O_2~-、H_2O_2、MDA水平在T1时均升高,SOD均降低,咪达唑仑组和对照组血清OH、O_2~-、H_2O_2、MDA在T2时均升高,SOD均降低(P0.05);与T0时相比,右美托咪定组血清OH、H_2O_2、MDA水平在T2时明显升高(P0.05),但右美托咪定组血清O_2~-、SOD水平在T2时差异无统计学意义(P0.05)。结论右美托咪定可减轻骨科下肢手术患者使用止血带诱发的肢体缺血-再灌注损伤。

Effects of dexmedetomidine treatment on tourniquet-induced ischemia-reperfusion injury in patients undergoing lower limb surgery

Objective To investigate the effects of dexmedetomidine treatment on tourniquet‐induced ischemia‐reperfusion injury in patients undergoing lower limb surgery .Methods 62 mechanically ventilated patients were randomly divided into dexmedetomi‐dine group(n=24) and midazolam group(n=23) and control group(n=15) .The loading dose and maintenance dose of dexmedeto‐midine were 1 μg/kg and 0 .5μg/(kg · h) ,and 0 .06 mg/kg and 0 .05μg/(kg · h) for midazolam .Patients in control group received saline infusion of the same dose at the same speed .The serum levels of hydroxy free radical(OH) ,superoxide anion(O2 - ) ,hydro‐gen peroxide(H2 O2 ) ,malondialdehyde(MDA) and superoxyde dismutase(SOD) were measured by using ELISA before the use of tourniquet(T0) ,at the time tourniquet release(T1) and 30 min after tourniquet release(T2) .Results The serum levels of oxidative stress related indicators showed no significant difference(P>0 .05) .At T1 ,the levels of OH ,O2 - ,H2 O2 ,MDA of dexmedetomi‐dine group were significantly lower than those of midazolam group and control group ,the levels of SOD of dexmedetomidine group were significantly higher than those of midazolam group and control group(P<0 .05) .At T2 ,the levels of O2 - and H2 O2 of dexme‐detomidine group were still lower than those of midazolam group and control group ,the levels of SOD of dexmedetomidine group were still significantly higher than that of midazolam group and control group(P<0 .05) .In the all three groups ,the levels of OH , O2 - ,H2O2 ,MDA at T1 were significantly higher but the levels of SOD were significantly lower than those indicators at T0(P<0 .05) .The levels of OH ,H2 O2 and MDA at T2 in dexmedetomidine group were significantly higher than those indicators at T2 (P<0 .05) ,but there were no significant different for O2 - and SOD in dexmedetomidine group at T0 and T2(P>0 .05) .Conclusion Dexmedetomidine treatment reduced the tourniquet‐induced ischemia‐reperfusion injury in patients undergoing lower limb surgery.