右美托咪定对下肢止血带手术糖尿病患者氧化应激和心肌损伤的影响
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摘要
目的观察术中应用右美托咪定是否能够减轻糖尿病患者的氧化应激反应,降低下肢止血带手术引起的心肌损伤。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患者80例,其中2型糖尿病患者40例,非糖尿病患者40例,按随机数字表法分为糖尿病右美托咪定组(D1,n=20),非糖尿病右美托咪定组(D2,n=20),糖尿病非右美托咪定组(C1,n=20)和非糖尿病非右美托咪定组(C2,n=20)。D1、D2组给予右美托咪定(初始剂量1μg/kg,维持剂量0.5μg·kg~(-1)·h~(-1)至术毕),C1、C2组以相同的方法给予生理盐水。分别于上止血带前(T0)和松止血带后15 min(T1)、1 h(T2)、24 h(T3)4个时间点采集静脉血测定丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、白细胞介素1β(interleukin-1β,IL-1β)、肌钙蛋白I(cardiac troponin I,cTnI)浓度。结果 4组MDA从T0～T2逐渐升高,到T3时下降,其组间、时点间差异均有统计学意义(P<0.05);4组SOD从T0～T2逐渐降低,到T3升高,其组间、时点间及组间·时点间交互作用差异均有统计学意义(P<0.05)。4组IL-1β和cTnI均从T0～T2逐渐升高,到T3时下降,组间、时点间及组间·时点间交互作用差异均有统计学意义(P<0.05)。结论糖尿病患者行下肢止血带手术更容易因缺血再灌注导致氧化应激和心肌损伤,右美托咪定能减轻其氧化应激反应,产生有效的心肌保护作用。
Objective To observe whether application of dexmedetomidine can reduce the oxidative stress response of diabetic patients and reduce the myocardial injury caused by lower limb tourniquet surgery. Methods Eighty patients under general anesthesia were accepted lower limb orthopedic surgery, forty patients with type 2 diabetes, forty patients without diabetes, were randomly divided into four groups using a random number table: diabetes dexmedetomidine group(D1, n=20), non-diabetic dexmedetomidine group(D2, n=20), diabetic non-dexmedetomidine group(C1, n=20) and non-diabetic non-dexmedetomidine group(C2, n=20). In the test group D1 and group D2,dexmedetomidine 1μg/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 control group C1 and group C2. Before the tourniquet(T0), after loose tourniquet 15 min(T1), 1 h(T2) and 24 h(T3), blood samples were collected for determination of malondialdehyde(MDA), superoxide dismutase(SOD), interleukin-1β(IL-1β), cardiac troponin I(cTnI) concentrations. Results The concentration of MDA in the four groups were firstly increased at T0～T2 and then decreased at T3, 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). The SOD were gradually decreased at T0～T2 and then increased at T3, while the levels of IL-1β and cTnI were firstly increased at T0～T2 and then decreased at T3 in the four groups, there were statistically significant differences between groups, time points and their interactions(P<0.05). Conclusion dexmedetomidine can reduce the oxidative stress response of diabetic patients, reduce the myocardial injury caused by lower limb tourniquet surgery, and produce effective myocardial protection.
Objective To observe whether application of dexmedetomidine can reduce the oxidative stress response of diabetic patients and reduce the myocardial injury caused by lower limb tourniquet surgery. Methods Eighty patients under general anesthesia were accepted lower limb orthopedic surgery, forty patients with type 2 diabetes, forty patients without diabetes, were randomly divided into four groups using a random number table: diabetes dexmedetomidine group(D1, n=20), non-diabetic dexmedetomidine group(D2, n=20), diabetic non-dexmedetomidine group(C1, n=20) and non-diabetic non-dexmedetomidine group(C2, n=20). In the test group D1 and group D2,dexmedetomidine 1μg/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 control group C1 and group C2. Before the tourniquet(T0), after loose tourniquet 15 min(T1), 1 h(T2) and 24 h(T3), blood samples were collected for determination of malondialdehyde(MDA), superoxide dismutase(SOD), interleukin-1β(IL-1β), cardiac troponin I(cTnI) concentrations. Results The concentration of MDA in the four groups were firstly increased at T0～T2 and then decreased at T3, 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). The SOD were gradually decreased at T0～T2 and then increased at T3, while the levels of IL-1β and cTnI were firstly increased at T0～T2 and then decreased at T3 in the four groups, there were statistically significant differences between groups, time points and their interactions(P<0.05). Conclusion dexmedetomidine can reduce the oxidative stress response of diabetic patients, reduce the myocardial injury caused by lower limb tourniquet surgery, and produce effective myocardial protection.
引文
[1] Jia G,Whaley-Connell A,Sowers JR.Diabetic cardiomyopathy:a hyperglycaemia and insulin-resistance-induced heart disease[J].Diabetologia,2018,61(1):21-28.
[2] 潘利亚,张晓卉,尹新华.糖尿病心肌病发病机制的研究进展[J].中国心血管杂志,2017,22(2):143-146.
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[4] 王莉,刘秀叶,郭琼梅,等.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[J].河北医科大学学报,2018,39(12):1438-1441,1446.
[5] 周娇洁,唐霓,魏继承.糖尿病心肌对缺血/再灌注损伤敏感化及其线粒体机制的研究进展[J].医学综述,2016,22(22):4460-4463.
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[8] 于沛霞,薄立军,黄立宁,等.p38MAPK/MMP-9信号通路对新生大鼠脑缺氧缺血损伤的影响[J].河北医科大学学报,2017,38(9):1063-1067.
[9] 胡静,谷小雨,孟炎,等.右美托咪定后处理对糖尿病大鼠心肌缺血再灌注损伤及炎症反应的影响[J].南方医科大学学报,2017,37(11):1506-1511.
[10] Chandramohan R,Saravanan S,Pari L,et al.Beneficial effects of tyrosol on altered glycoprotein components in streptozotocin-induced diabetic rats [J].Pharm Biol,2017,55(1):1631-1637.
[11] Riquelme JA,Westermeier F,Hall AR,et al.Dexmedetomidine protects the heart against ischemia-reperfusion injury by an endothelial eNOS/NO dependent mechanism [J].Pharmacol Res,2016,103:318-327.
[12] 王鹏.右美托咪定预处理对止血带性心肌损伤的保护作用[J].天津医科大学学报,2016,22(1):64-65.
[13] 蔡翼,罗红霞,彭明清.右美托咪定对冠心病患者非心脏手术中血流动力学的影响和心肌保护作用[J].中国老年学杂志,2017,37(19):4853-4854.
[14] 卢孙山,杨勇,杨智勇,等.右美托咪定对骨科止血带所致缺血再灌注患者炎症反应、氧化应激及内皮功能的影响[J].海南医学院学报,2017,23(20):2787-2790.
[15] 罗琳,魏晓,陈梅珠,等.体外循环期间应用右美托咪定对猪外周血单核细胞TLR-4,5/NF-κB信号通路的影响[J].实用医学杂志,2018,34(22):3774-3778.
[16] 汪忠玉,曾资平,张燕,等.右美托咪定对糖尿病大鼠肺组织Toll样受体4表达的影响[J].山西医科大学学报,2018,49(3):222-225.
[2] 潘利亚,张晓卉,尹新华.糖尿病心肌病发病机制的研究进展[J].中国心血管杂志,2017,22(2):143-146.
[3] 齐晓丹,常凌峰,于海涛,等.糖尿病心肌病患者内源性抗氧化体系及氧化应激水平[J].实用医学杂志,2018,34(8):1231-1234.
[4] 王莉,刘秀叶,郭琼梅,等.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[J].河北医科大学学报,2018,39(12):1438-1441,1446.
[5] 周娇洁,唐霓,魏继承.糖尿病心肌对缺血/再灌注损伤敏感化及其线粒体机制的研究进展[J].医学综述,2016,22(22):4460-4463.
[6] Walters JW,Amos D,Ray K,et al.Mitochondrial redox status as a target for cardiovascular disease[J].Curr Opin Pharmacol,2016,27:50-55.
[7] 卢丹丹,王佩,万莉,等.缺血性卒中患者血清尿酸水平与TAC、MDA及临床预后的相关性[J].河北医科大学学报,2017,38(11):1248-1252.
[8] 于沛霞,薄立军,黄立宁,等.p38MAPK/MMP-9信号通路对新生大鼠脑缺氧缺血损伤的影响[J].河北医科大学学报,2017,38(9):1063-1067.
[9] 胡静,谷小雨,孟炎,等.右美托咪定后处理对糖尿病大鼠心肌缺血再灌注损伤及炎症反应的影响[J].南方医科大学学报,2017,37(11):1506-1511.
[10] Chandramohan R,Saravanan S,Pari L,et al.Beneficial effects of tyrosol on altered glycoprotein components in streptozotocin-induced diabetic rats [J].Pharm Biol,2017,55(1):1631-1637.
[11] Riquelme JA,Westermeier F,Hall AR,et al.Dexmedetomidine protects the heart against ischemia-reperfusion injury by an endothelial eNOS/NO dependent mechanism [J].Pharmacol Res,2016,103:318-327.
[12] 王鹏.右美托咪定预处理对止血带性心肌损伤的保护作用[J].天津医科大学学报,2016,22(1):64-65.
[13] 蔡翼,罗红霞,彭明清.右美托咪定对冠心病患者非心脏手术中血流动力学的影响和心肌保护作用[J].中国老年学杂志,2017,37(19):4853-4854.
[14] 卢孙山,杨勇,杨智勇,等.右美托咪定对骨科止血带所致缺血再灌注患者炎症反应、氧化应激及内皮功能的影响[J].海南医学院学报,2017,23(20):2787-2790.
[15] 罗琳,魏晓,陈梅珠,等.体外循环期间应用右美托咪定对猪外周血单核细胞TLR-4,5/NF-κB信号通路的影响[J].实用医学杂志,2018,34(22):3774-3778.
[16] 汪忠玉,曾资平,张燕,等.右美托咪定对糖尿病大鼠肺组织Toll样受体4表达的影响[J].山西医科大学学报,2018,49(3):222-225.