天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (5): 537-541.doi: 10.11958/j.issn.0253-9896.2015.05.024

• 药物临床观察 • 上一篇    下一篇

右美托咪啶预处理对下肢缺血再灌注性肺损伤及一氧化氮/内皮素-1失衡的影响

于健， 李睿， 王琦?#br# #br#   

  1. 河北省沧州市中心医院麻醉一科 （邮编 061001）
  • 收稿日期:2014-09-16 修回日期:2014-12-11 出版日期:2015-05-15 发布日期:2015-05-25
  • 通讯作者: 王琦,E-mail:viviyjyy@sina.com E-mail:viviyjyy@sina.com
  • 作者简介: 于健 （1981）， 男， 主治医师， 硕士， 主要从事骨科麻醉方面研究

Effects of dexmedetomidine preconditioning on imbalance of nitric oxide/endothelin-1 and remote lung injury in patients with lower limb ischemia-reperfusion

YU Jian， LI Rui， WANG Qi?#br# #br#   

  1. Department of Anesthesiology, Central Hospital of Cangzhou, Hebei 061001, China
  • Received:2014-09-16 Revised:2014-12-11 Published:2015-05-15 Online:2015-05-25
  • Contact: WANG Qi,E-mail:viviyjyy@sina.com E-mail:viviyjyy@sina.com

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摘要： 摘要： 目的 观察右美托咪啶预处理对止血带引起的肢体缺血/再灌注 （LIR） 致肺损伤的保护作用和对一氧化氮（NO） /内皮素 （ET） -1 失衡的影响。方法 选取 60 例 ASA 评分Ⅰ～Ⅱ级拟行单侧下肢手术的患者。随机分为对照组 （R 组， n=30） 和右美托咪啶预处理组 （PD 组， n=30）。所有患者均在神经刺激仪引导下行腰丛-坐骨神经阻滞麻醉后手术。PD 组于使用止血带前 10 min 静脉泵注右美托咪啶 0.125 mL/kg （4 mg/L）； R 组在相应时间点给予等量生理盐水 0.125 mL/kg。分别于使用止血带前 10 min（T0）和松止血带后 15 min（T1）、 2 h（T2）、 6 h（T3）及 24 h（T4）行动脉血气分析， 计算呼吸指数（RI）和氧和指数（OI）， 测定 NO、 ET-1、 白细胞介素（IL） -8、 丙二醛（MDA）水平。结果 与 T0 比较， R 组 T3时 RI 升高， T2~T4时 OI 降低 （P＜0.01）， PD 组各时点 RI、 OI 值比较差异无统计学意义； R 组和 PD 组在松止血带后 ET-1、 IL-8、 MDA 浓度升高， NO 浓度、 NO/ET-1 比值显著降低 （P＜0.05）。与 R 组比较， PD 组在 T3时 RI 降低、 OI 升高 （P＜0.01）； PD 组在松止血带后 ET-1、 IL-8、 MDA、 NO 浓度和 NO/ET-1 比值与 R 组比较差异有统计学意义（P＜0.05）。R 组患者血浆 ET-1、 IL-8 水平与 RI 值呈正相关， 与 OI 值呈负相关（P < 0.01）； 血浆 NO 水平、 NO/ ET-1 比值与 RI 值呈负相关， 与 OI 值呈正相关 （P < 0.01）。结论 右美托咪啶预处理通过保护内皮细胞和减轻脂质过氧化损伤， 改善患者使用止血带造成的 LIR 致肺换气功能的障碍。

关键词: 右美托咪啶, 肢体缺血再灌注, 肺换气, 一氧化氮, 内皮缩血管肽1

Abstract: Abstract： Objective To investigate the effects of dexmedetomidine preconditioning on nitric oxide (NO)/endothelin (ET)-1 imbalance and remote lung injury induced by lower limb ischemia-reperfusion (LIR). Methods Sixty patients who scheduled for unilateral lower extremity surgery matched American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ, were random⁃ ized into two groups: control group (R group, n=30) and dexmedetomidine preconditioning group (PD group, n=30). Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups. In group PD, dexme⁃ detomidine intravenous infusion was started at a dose of 0.125 mL /kg (4 mg/L) for 10 minutes before using tourniquet, where⁃ as group R received an equivalent volume of normal saline. Artery blood gas analysis, respiratory index and oxygenation in⁃ dex were measured, and NO, ET-1, interleukin-8 (IL-8) and malondialdehyde (MDA) concentrations were determined from plasma samples 10 minutes before tourniquet inflation (T0), 15 minutes (T1), 2 h (T2), 6 h (T3) and 24 h (T4) after tourniquet deflation. Results Compared with T0, RI was higher at T3 in group R and OI was lower at T2-4 (P < 0.01). There were no signifi⁃ cant differences in RI and OI of group PD between different time points (P > 0.05). In R and PD groups, ET-1, IL-8 and MDA concentrations were increased, while NO level and NO/ET-1 ratio were significantly decreased after tourniquet defla⁃ tion (P＜0.05). Compared with group R, RI was lower and OI was higher at T3 in group PD (P < 0.01). The levels of ET-1, IL-8, MDA, NO and NO/ET-1 ratio were significantly different after tourniquet deflation between group PD and group R (P＜0.05). In group R, there was positive correlation between ET-1 and IL-8 levels with RI, and negative correlation be⁃ tween ET-1 and IL-8 levels with OI (P < 0.01). There was positive correlation between NO level, NO/ET-1 ratio and RI lev⁃el (P <0.01). Conclusion Lung function impairment induced by tourniquet application could be attenuated by dexmedeto⁃ midine preconditioning based on protecting endothelial cells and inhibiting lipid peroxidation.

Key words: Dexmedetomidine, Limb ischemia-reperfusion, Pulmonary gas exchange, nitric oxide, Endothelin-1