河北医科大学学报

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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

  

  1. 河北医科大学第一医院麻醉科，河北 石家庄 050031
  • 出版日期:2018-12-25 发布日期:2018-11-30
  • 作者简介:王莉（1979-），女，河北沧州人，河北医科大学第一医院副主任医师，医学硕士，从事临床麻醉学研究。
  • 基金资助:
    河北省医学科学研究重点课题（20160698）

Effects of dexmedetomidine on inflammatory response, insulin resistance and myocardial injury caused by lower limb tourniquet surgery in diabetic patients#br#

  1. Department of Anesthesiology, the First Hospital of Hebei Medical University, Shijiazhuang 050031, China
  • Online:2018-12-25 Published:2018-11-30

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摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗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。
〖HTH〗方法〖HTSS〗〖KG*2〗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1 μg/kg右美托咪定（给药时间15 min），之后以0.5 μg·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15 min(T1)、松止血带后1 h（T2）和松止血带后12 h(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。
〖HTH〗结果〖HTSS〗〖KG*2〗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)。
〖HTH〗结论〖HTSS〗〖KG*2〗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。

关键词: 糖尿病, 2型, 右美托咪定, 止血带

Abstract: ［Abstract］〓Objective〖HTSS〗〓To investigate the effects of dexmedetomidine on inflammatory response, insulin resistance and myocardial injury caused by lower limb tourniquet surgery in diabetic patients.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓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 1 μg/kg (initial dose) was given(15 min) after induction of anesthesia，followed by continuous infusion at 0.5 μg·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 factor α(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．
〖HTH〗〖WTHZ〗Results〖HTSS〗〓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).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓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.

Key words: diabetes mellitus, type 2； dexmedetomidine, tourniquets

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