右美托咪定对糖尿病患者围术期心肌保护及心血管功能调控作用
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摘要
目的探讨右美托咪定(Dexmedetomidine,Dex)对糖尿病患者围术期心肌保护及心血管功能调控作用。方法选择在椎管内麻醉下行择期膝、髋关节置换的糖尿病患者48例,年龄65-87岁,ASA分级Ⅱ-Ⅲ级。随机分为DEX治疗组(DEX组,22例)和非DEX治疗组(non-DEX组,26例)。于平面固定后,D组患者静脉输注右美托咪定0. 4μg/kg,输注时间10 min,随后以0. 4μg/(kg·h)的速率持续输注至术毕。non-DEX组给予等剂量生理盐水。比较分析两组患者围术期心血管事件发生情况,并测定术前、术毕血糖值及术前30 min(T_0)、术后24 h(T_1)血浆心肌肌钙蛋白I(cardiac troponin I,cTnI)、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)浓度。结果两组患者术前血糖值、血浆cTnI、CGRP浓度差异均未显示统计学意义(P> 0. 05)。DEX组心血管事件总发生率、术毕血糖值及术毕较术前血糖值增加幅度、术后24 h CGRP浓度降低幅度均低于non-DEX组(P <0. 05)。与同组术前相比,non-DEX组术后24 h cTnI浓度升高(P <0. 05),而DEX组cTnI浓度未见明显变化(P> 0. 05)。结论右美托咪定可能具有稳定糖尿病患者围术期心血管功能以及心肌保护作用。
Objective To investigate the effects of dexmedetomidine( DEX) on perioperative myocardial protection and cardiovascular regulatory function in diabetic patients. Methods Forty-eight patients with diabetes mellitus,aged 65-87 years,ASA Ⅱ-Ⅲ,underwent elective knee and hip replacement under spinal anesthesia. They were randomly divided into DEX group( n = 22) and nonDEX group( n = 26). After planar fixation,patients in DEX group were intravenously infused with 0. 4 μg/kg dexmedetomidine for 10 min,followed by continuous infusion at a rate of 0. 4 μg/( kg·h). The patients in non-DEX group were given an equal dose of physiological saline. The perioperative cardiovascular events were compared between the two groups,and the preoperative and postoperative blood glucose values,plasma troponin I( cTnI),calcitonin gene-related peptide( CGRP) concentration at preoperative 30 min( T_0) and postoperative 24 h( T_1) were measured. Results There were no significant differences in preoperative blood glucose,plasma cTnI and CGRP concentrations between the two groups( P > 0. 05). The total incidence of cardiovascular events,the blood glucose level,the increase of blood glucose before and after operation,and the decrease of CGRP concentration at 24 h after surgery in DEX group were lower than those in non-DEX group( P < 0. 05). The concentration of cTnI in non-DEX group increased 24 h after operation( P < 0. 05),but there was no significant change in the concentration of cTnI in DEX group( P > 0. 05). Conclusion Dexmedetomidine may have stable perioperative cardiovascular function and myocardial protection in diabetic patients.
Objective To investigate the effects of dexmedetomidine( DEX) on perioperative myocardial protection and cardiovascular regulatory function in diabetic patients. Methods Forty-eight patients with diabetes mellitus,aged 65-87 years,ASA Ⅱ-Ⅲ,underwent elective knee and hip replacement under spinal anesthesia. They were randomly divided into DEX group( n = 22) and nonDEX group( n = 26). After planar fixation,patients in DEX group were intravenously infused with 0. 4 μg/kg dexmedetomidine for 10 min,followed by continuous infusion at a rate of 0. 4 μg/( kg·h). The patients in non-DEX group were given an equal dose of physiological saline. The perioperative cardiovascular events were compared between the two groups,and the preoperative and postoperative blood glucose values,plasma troponin I( cTnI),calcitonin gene-related peptide( CGRP) concentration at preoperative 30 min( T_0) and postoperative 24 h( T_1) were measured. Results There were no significant differences in preoperative blood glucose,plasma cTnI and CGRP concentrations between the two groups( P > 0. 05). The total incidence of cardiovascular events,the blood glucose level,the increase of blood glucose before and after operation,and the decrease of CGRP concentration at 24 h after surgery in DEX group were lower than those in non-DEX group( P < 0. 05). The concentration of cTnI in non-DEX group increased 24 h after operation( P < 0. 05),but there was no significant change in the concentration of cTnI in DEX group( P > 0. 05). Conclusion Dexmedetomidine may have stable perioperative cardiovascular function and myocardial protection in diabetic patients.
引文
[1]闫丽璇,张瑞林,郭政.糖尿病患者血浆SP和CGRP浓度与术中心血管事件的关系[J].中华麻醉学杂志,2017,37(6):649-652.
[2]Kee Z,Kodji X,Brain SD.The role of calcitonin gene related peptide(CGRP)in neurogenic vasodilation and its cardioprotective effects[J].Front Physiol,2018,9:1249.
[3]Aubdool AA,Thakore P,Argunhan F,et al.A novelα-calcitonin gene-related peptide analogue protects against end-organ damage in experimental hypertension,cardiac hypertrophy,and heart failure[J].Circulation,2017,136(4):367-383.
[4]Huang MH,Nguyen V,Wu Y,et al.Reducing ischaemia/reperfusion injury throughδ-opioid-regulated intrinsic cardiac adrenergic cells:Adrenopeptidergic co-signalling[J].Cardiovascular Research,2009,84(3):452-460.
[5]Krolikowska M,Kataja M,P9yhiR,et al.Mortality in diabetic patients undergoing non-cardiac surgery:a 7-year follow-up study[J].Acta Anaesthesiol Scand,2009,53(6):749-758.
[6]Nehme Z,Stub D,Bernard S,et al.Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction[J].Heart,2016,102(6):444-451.
[7]夏乐强,王瑛,张先杰,等.不同剂量右美托咪啶对有心血管风险老年患者围术期心脏的保护作用[J].中国老年学杂志,2017,37(16):4040-4042.
[8]杨凯杰,罗戎明,陈骏萍,等.低剂量右美托咪定对老年糖尿病患者围术期循环及心率变异性的影响[J].中国现代医生,2016,54(32):112-115.
[9]Chalikonda SA.Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events[J].AANA J,2009,77(2):103-108.
[10]Li TP,Guo Z,Liu CJ,et al.Association of down-regulation of calcitonin gene-related peptide and substance P with increase of myocardial vulnerability in diabetic neuropathic rats[J].Peptides,2017,96:1-7.
[11]Ma YX,Guo Z,Sun T.CGRP inhibits norepinephrine induced apoptosis with restoration of Bcl-2/Bax in cultured cardiomyocytes of rat[J].Neurosci Lett,2013,549(33):130-134.
[12]王鑫,原大江,郭政.降钙素基因相关肽对大鼠心室肌细胞膜ATP敏感性钾离子通道的影响[J].临床麻醉学杂志,2014,30(4):396-399.
[13]Guo Z,Liu N,Chen L,et al.Independent roles of CGRP in cardioprotection and hemodynamic regulation in ischemic postconditioning[J].Eur J Pharmacol,2018,828:18-25.
[14]Lee E,Jung DY,Kim JH,et al.Transient receptor potential vanilloid type-1 channel regulates diet-induced obesity,insulin resistance,and leptin resistance[J].FASEB J,2015,29(8):3182-3192.
[2]Kee Z,Kodji X,Brain SD.The role of calcitonin gene related peptide(CGRP)in neurogenic vasodilation and its cardioprotective effects[J].Front Physiol,2018,9:1249.
[3]Aubdool AA,Thakore P,Argunhan F,et al.A novelα-calcitonin gene-related peptide analogue protects against end-organ damage in experimental hypertension,cardiac hypertrophy,and heart failure[J].Circulation,2017,136(4):367-383.
[4]Huang MH,Nguyen V,Wu Y,et al.Reducing ischaemia/reperfusion injury throughδ-opioid-regulated intrinsic cardiac adrenergic cells:Adrenopeptidergic co-signalling[J].Cardiovascular Research,2009,84(3):452-460.
[5]Krolikowska M,Kataja M,P9yhiR,et al.Mortality in diabetic patients undergoing non-cardiac surgery:a 7-year follow-up study[J].Acta Anaesthesiol Scand,2009,53(6):749-758.
[6]Nehme Z,Stub D,Bernard S,et al.Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction[J].Heart,2016,102(6):444-451.
[7]夏乐强,王瑛,张先杰,等.不同剂量右美托咪啶对有心血管风险老年患者围术期心脏的保护作用[J].中国老年学杂志,2017,37(16):4040-4042.
[8]杨凯杰,罗戎明,陈骏萍,等.低剂量右美托咪定对老年糖尿病患者围术期循环及心率变异性的影响[J].中国现代医生,2016,54(32):112-115.
[9]Chalikonda SA.Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events[J].AANA J,2009,77(2):103-108.
[10]Li TP,Guo Z,Liu CJ,et al.Association of down-regulation of calcitonin gene-related peptide and substance P with increase of myocardial vulnerability in diabetic neuropathic rats[J].Peptides,2017,96:1-7.
[11]Ma YX,Guo Z,Sun T.CGRP inhibits norepinephrine induced apoptosis with restoration of Bcl-2/Bax in cultured cardiomyocytes of rat[J].Neurosci Lett,2013,549(33):130-134.
[12]王鑫,原大江,郭政.降钙素基因相关肽对大鼠心室肌细胞膜ATP敏感性钾离子通道的影响[J].临床麻醉学杂志,2014,30(4):396-399.
[13]Guo Z,Liu N,Chen L,et al.Independent roles of CGRP in cardioprotection and hemodynamic regulation in ischemic postconditioning[J].Eur J Pharmacol,2018,828:18-25.
[14]Lee E,Jung DY,Kim JH,et al.Transient receptor potential vanilloid type-1 channel regulates diet-induced obesity,insulin resistance,and leptin resistance[J].FASEB J,2015,29(8):3182-3192.