右美托咪定对骨科下肢手术患者止血带诱发炎症的影响及机制研究

摘要

Objective To investigate the influence of dexmedetomidine on tourniquet‐induced inflammation in the patients with lower limb surgery .Methods Forty‐eight patients needing lower limb surgery in the orthopedic department of our hospital from June 2013 to March 2015 were divided into the dexmedetomidine group and control group according to the random number table ,24 cases in each group .All cases adopted the subarachnoid block combined with epidural anesthesia .The dexmedetomidine group was given the loading dose of dexmedetomidine 1μg/kg after puncture and maintenance dose of dexmedetomidine 0 .5μg/(kg・h) .The control group was given the same volume of normal saline .The serum levels of TNF‐α,IL‐6 ,ICAM‐1 and NF‐κB were measured by enzyme‐linked immunosorbent assay(ELISA) before using tourniquet(T1) ,at the time of tourniquet release(T2) and 30 min after tourniquet release(T3) .Results The incidence rate of bradycardia in the dexmedetomidine group was significantly higher than that in the control group(P<0 .05);the levels of serum inflammatory factors at T0 showed no statistically significant difference between two groups (P>0 .05) .The levels of serum inflammatory factors at T1 ,T2 in the two groups were significantly higher than those at T0 ,the difference was statistically significant(P<0 .05) .The levels of TNF‐α,IL‐6 ,ICAM‐1 and NF‐κB at T1 ,T2 in the dexme‐detomidine group were significantly lower than those in the control group ,the differences were statistically significant(P<0 .05) . Conclusion Dexmedetomidine might alleviate the tourniquet‐induced inflammation reaction process in the patients with lower limb surgery via down‐regulating serum NF‐κB level .%目的：探讨右美托咪定对骨科下肢手术患者止血带导致炎症过程的影响。方法将2013年6月到2015年3月该院骨科病房收治的48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及对照组，每组24例。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）。对照组给予同等容量生理盐水。于使用止血带前（T1），松开止血带时（T2），松开止血带后30 min（T3）时，采用酶联免疫吸附法（ELISA）检测血清肿瘤坏死因子‐α（TNF‐α），白细胞介素‐6（IL‐6），细胞间黏附分子‐1（ICAM‐1）、核转录因子（NF‐κB）的变化情况。结果右美托咪定组患者心动过缓发生率显著高于对照组，差异具有统计学意义（P＜0．05）；两组患者血清各炎症因子水平在T0时差异无统计学意义（P＞0．05）；与T0相比，两组患者血清各炎症因子水平在T1和T2时均显著升高，且差异具有统计学意义（P＜0．05）；右美托咪定组患者血清TNF‐α、IL‐6、ICAM‐1、NF‐κB水平在T1和T2时均显著低于对照组，差异有统计学意义（P＜0．05）。结论右美托咪定可能通过降低血清NF‐κB水平来减轻骨科下肢手术患者使用止血带诱发的炎性反应过程。