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| 右美托咪定对老年糖尿病患者腹部肿瘤根治术后心肌损伤的影响 |
| Effects of dexmedetomidine on myocardial injury after abdominal tumor radical surgery in elderly diabetic patients |
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| DOI：10.12089/jca.2023.10.001 |
| 中文关键词: 右美托咪定 糖尿病 腹部手术 心肌损伤 肿瘤 |
| 英文关键词: Dexmedetomidine Diabetes mellitus Abdominal surgery Myocardial injury Neoplasms |
| 基金项目:国家自然科学基金（81960053） |
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| 中文摘要: |
目的 探讨右美托咪定对老年糖尿病患者腹部肿瘤根治术后心肌损伤的影响。
方法 选择择期行腹部肿瘤根治术的2型糖尿病患者92例，男50例，女42例，年龄≥65岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：右美托咪定组（D组）和对照组（C组）。D组于麻醉诱导前静脉泵注右美托咪定1 μg/kg，给药时间为10～15 min，随后以0.5 μg·kg-1·h-1的速度静脉泵注至手术结束前30 min；C组给予等量生理盐水。记录入室时、术毕即刻、术后6、24 h时血浆肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、丙二醛（MDA）、超氧化物歧化酶（SOD）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-10（IL-10）的浓度、HR和MAP。记录术中不良事件（低血压、心动过缓以及心动过速）的发生情况。记录入PACU 10 min时、出PACU时、术后6、24 h的疼痛数字评价量表（NRS）评分。记录术后拔管时间、PACU停留时间、苏醒期躁动、术后心血管事件（低血压、心动过缓、室性早搏、心肌缺血）的发生情况。
结果 与入室时比较，术毕即刻、术后6、24 h 两组CK-MB、cTnI、MDA、TNF-α、IL-6、IL-10浓度明显升高（P＜0.05），SOD浓度明显降低（P＜0.05），术毕即刻两组MAP明显降低（P＜0.05），C组HR明显减慢（P＜0.05）。与C组比较，术毕即刻、术后6、24 h D组CK-MB、cTnI、MDA、TNF-α、IL-6浓度明显降低（P＜0.05），SOD、IL-10浓度明显升高（P＜0.05），术毕即刻HR明显增快（P＜0.05），MAP明显升高（P＜0.05），术中低血压、心动过速、入PACU 10 min和出PACU NRS评分以及苏醒期躁动、术后低血压、心动过缓的发生率明显降低（P＜0.05）。
结论 右美托咪定可改善老年糖尿病患者腹部肿瘤根治术后的氧化应激及炎症反应，减轻术后心肌损伤。 |
| 英文摘要: |
Objective To investigate the effects of dexmedetomidine on myocardial injury in elderly diabetic patients after abdominal tumor radical surgery.
Methods Ninety-two patients with type 2 diabetes mellitus undergoing elective abdominal tumor radical surgery were enrolled, 50 males and 42 females, aged ≥ 65 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ. Patients were randomly divided into conventional anesthesia group (group C) and dexmedetomidine group (group D). Dexmedetomidine 1 μg/kg was injected intravenously for 10-15 minutes before induction of anesthesia, followed by 0.5 μg·kg-1·h-1 until 30 minutes before the end of surgery in group D, and the same amount of normal saline was given in group C. The levels of creatine kinase isoenzyme (CK-MB), troponin I (cTnI), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in plasma, HR and MAP were recorded at the time of entering the operating room, immediately after the end of operation, 6 and 24 hours after operation. The incidences of intraoperative adverse events (hypotension, bradycardia and tachycardia) were recorded. Numerical rating scale (NRS) scores were recorded after 10 minutes entering into PACU, after exiting PACU, 6 and 24 hours after operation. The extubation time, length of PACU stay, incidence of emergence agitation, occurrence of postoperative cardiovascular events (hypotension, bradycardia, arrhythmia, myocardial ischemia) were recorded.
Results Compared with entering the operating room, the levels of CK-MB, cTnI, MDA, TNF-α, IL-6, and IL-10 were significantly increased immediately after the end of operation, 6 and 24 hours after operation (P < 0.05), the level of SOD was significantly decreased (P < 0.05), MAP decreased significantly immediately after the end of operation (P < 0.05), and HR decreased significantly in group C (P < 0.05). Compared with group C, the levels of CK-MB, cTnI, MDA, TNF-α, and IL-6 were significantly decreased in group D immediately after the end of operation, 6 and 24 hours after operation (P < 0.05), the levels of SOD and IL-10 were significantly increased (P < 0.05), HR and MAP increased significantly in group D immediately after the end of operation (P < 0.05), the incidence of intraoperative hypotension, tachycardia, NRS score 10 minutes after entering into PACU and after exiting PACU, incidence of agitation during the recovery period, postoperative hypotension, bradycardia were significantly decreased (P < 0.05).
Conclusion Dexmedetomidine can improve oxidative stress and inflammatory response in diabetic patients after abdominal tumor radical surgery, and reduce myocardial injury after surgery. |
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