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| 右美托咪定复合七氟醚后处理对糖尿病患者心肌缺血-再灌注损伤的影响 |
| Effect of dexmedetomidine combined with sevoflurane postprocessing on myocardial ischemia-reperfusion injury in diabetic patients |
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| DOI：10.12089/jca.2021.09.003 |
| 中文关键词: 右美托咪定 七氟醚后处理 缺血-再灌注损伤 炎症反应 氧化应激 |
| 英文关键词: Dexmedetomidine Sevoflurane post-treatment Myocardial ischemia reperfusion injury Oxidative stress Inflammatory response |
| 基金项目:江西省卫生健康委普通科技计划项目(202130476) |
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| 中文摘要: |
目的 探讨右美托咪定联合七氟醚后处理对糖尿病患者心肌缺血-再灌注损伤的影响。
方法 选择2019年6月至2020年12月拟在全麻下行心脏瓣膜置换术的2型糖尿病患者80例,男42例,女38例,年龄41~65岁,BMI 18~25 kg/m2,ASA Ⅱ或Ⅲ级,心功能NYHA Ⅱ或Ⅲ级,肝、肾功能正常。采用随机数字表法分为四组：七氟醚后处理组(S组)、右美托咪定组(D组)、右美托咪定复合七氟醚后处理组(SD组)和对照组(C组),每组20例。S组于主动脉开放时经体外循环机给予2％七氟醚15 min；D组于手术开始时予右美托咪定0.5 μg·kg-1·h-1持续泵注直至手术结束；SD组于手术开始时予右美托咪定0.5 μg·kg-1·h-1持续泵注直至手术结束,于主动脉开放时经体外循环机给予2％七氟醚15 min；C组泵注等体积生理盐水且不使用任何吸入性麻醉药。分别于主动脉阻断前(T0)和主动脉开放后6 h(T1)、24 h(T2)、48 h(T3)采集中心静脉血样,检测血浆肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)的活性和肌钙蛋白I(TnI)、TNF-α、IL-6、NF-κB、血红素氧合酶-1(HO-1)的浓度,记录术中胰岛素使用、心脏起搏器置入、心脏自动复跳情况。
结果 与T0时比较,T1—T3时四组血浆CK、CK-MB、LDH活性及cTnI、TNF-α、IL-6、NF-κB、HO-1浓度明显升高(P<0.05),SOD活性明显降低(P<0.05)。与C组比较,D组和SD组T1—T3时血浆CK、CK-MB、LDH活性及cTnI、TNF-α、IL-6、NF-κB浓度明显降低(P<0.05),SOD活性、HO-1浓度明升高(P<0.05),胰岛素使用率明显降低(P<0.05),心脏自动复跳率明显升高(P<0.05)。与D组比较,SD组T1—T3时血浆CK、CK-MB、LDH活性及cTnI、TNF-α、IL-6、NF-κB浓度明显降低(P<0.05),SOD活性、HO-1浓度明升高(P<0.05),心脏起搏器置入率明显降低(P<0.05),心脏自动复跳率明显升高(P<0.05)。C组和S组T1—T3时血浆CK、CK-MB、LDH、SOD活性及cTnI、TNF-α、IL-6、NF-κB、HO-1浓度以及胰岛素使用率、心脏起搏器置入率、心脏自动复跳率差异无统计学意义。
结论 右美托咪定可以减轻糖尿病患者心肌缺血-再灌注损伤,并恢复糖尿病患者的抗炎、抗氧化能力,复合七氧醚后处理可以进一步减轻糖尿病患者心肌缺血-再灌注损伤。 |
| 英文摘要: |
Objective To explore the Effect of dexmedetomidine combined with sevoflurane postprocessing on myocardial ischemia-reperfusion injury in diabetic patients.
Methods Eighty patients with type 2 diabetes who were planning to undergo heart valve replacement under general anesthesia from June 2019 to December 2020 were enrolled,42 males and 38 females, aged 41-65 years, BMI 18-25 kg/m2, ASA physical status Ⅱ or Ⅲ, NYHA cardiac function classification Ⅱ or Ⅲ, liver and kidney function are normal. Patients were divided into four groups by using a random number table method: sevoflurane post-treatment group (group S), dexmedetomidine group (group D), dexmedetomidine combined with sevoflurane post-treatment group (group SD) and control group (group C), 20 patients in each group. Group S was given 2% sevoflurane via the cardiopulmonary bypass machine for 15 minutes when the aorta was open, group D was given dexmedetomidine 0.5 μg·kg-1·h-1 at the beginning of the operation until the end of the operation, group SD was given dexmedetomidine 0.5 μg·kg-1·h-1 at the beginning of the operation until the end of the operation, and 2% sevoflurane was given via the cardiopulmonary bypass machine for 15 minutes when the aorta was open, group C was pumped with the same amount of normal saline and no inhalation was used Anesthetics. Central venous blood samples were collected before aortic clamping (T0) and 6 hours (T1), 24 hours (T2) and 48 hours (T3) after aortic declamping. Plasma creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), superoxide dismutase (SOD) activity and the concentration of troponin I (TnI), TNF-α, IL-6, NF-κB and heme oxygenase-1 (HO-1) were measured. The intraoperative use of insulin, implantation of pacemaker and automatic cardiac resuscitation were recorded.
Results Compared with T0, plasma CK, CK-MB, LDH activities and cTnI, TNF-α, IL-6, NF-κB, HO-1 concentrations in the 4 groups at T1-T3 increased significantly, while SOD activity decreased (P < 0.05). Compared with group C, the activities of CK, CK-MB, LDH and the concentrations of cTnI, TNF-α, IL-6 and NF-κB in plasma decreased significantly at T1-T3 (P < 0.05), SOD and the concentration of HO-1 increased significantly at T1-T3 (P < 0.05), the utilization rate of insulin decreased significantly (P < 0.05), the rate of spontaneous cardiac resuscitation increased significantly (P < 0.05) in groups D and SD. Compared with group D, the activity of CK, CK-MB, LDH and the concentration of cTnI, TNF-α, IL-6 and NF-κB in plasma at T1-T3 decreased significantly (P < 0.05), SOD and the concentration of HO-1 increased significantly at T1-T3(P < 0.05), the implanted rate of pacemaker decreased significantly (P < 0.05), the rate of spontaneous cardiac resuscitation increased significantly (P < 0.05) in group SD. There were no significant differences in plasma CK, CK-MB, LDH, SOD activity and cTnI, TNF-α, IL-6, NF-κB, HO-1 concentration at T1-T3, insulin utilization rate, cardiac pacemaker implantation rate, and automatic cardiac resuscitation rate between groups C and S.
Conclusion Dexmedetomidine can reduce myocardial ischemia reperfusion injury in diabetic patients, restore the anti-inflammatory and antioxidant abilities of diabetic patients, and alleviate myocardial ischemia reperfusion injury in diabetic patients． |
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