右美托咪定预先给药下调HMGB1和sRAGE水平减轻肢体缺血再灌注远隔肺损伤

发布时间：2018-04-07 15:04

本文选题：右美托咪定　切入点：再灌注损伤　出处：《中国新药与临床杂志》2017年03期

【摘要】：目的观察右美托咪定预处理对下肢手术患者止血带松开后高迁移率族蛋白1(HMGB1)和可溶性晚期糖基化终末产物受体(sRAGE)水平的影响。方法择期应用止血带行单侧下肢手术患者60例,均行腰硬联合麻醉,随机分为对照组和试验组,每组30例。试验组静脉泵注右美托咪定负荷剂量1μg·kg~(-1),15 min完成,随后以0.5μg·kg~(-1)·h~(-1)静脉泵注至术毕;对照组以相同速率静脉泵注等容量氯化钠注射液。待负荷剂量泵注完成后上止血带。于扎止血带前(T_0),松止血带后30 min(T_1)、2 h(T_2)、6 h(T_3)和24 h(T_4)时抽取桡动脉血行血气分析,留取血清检测HMGB1和sRAGE浓度。记录术中不良反应的发生情况。结果与T0时比较,T3时两组动脉氧分压(PaO2)均降低(P0.05),肺泡气-动脉血氧分压差(PA-aO2)和呼吸指数(RI)均升高(P0.05);T_3时试验组PaO_2高于对照组(P0.05),PA-aO_2和RI低于对照组(P0.05)。与T_0时比较,两组患者T_1~T_4时HMGB1和sRAGE均升高(P0.05),对照组高于试验组(P0.05)。试验组心动过缓发生率17%(5/30),高于对照组(P0.05),恶心、烦躁等发生率组间无显著差异。结论右美托咪定预先给药可降低下肢手术患者止血带松开后血清HMGB1和sRAGE水平,减轻肺损伤。
[Abstract]:Objective to investigate the effects of dexmetomidine preconditioning on the levels of high mobility group protein (HMGB1) and soluble advanced glycosylation end product receptor (sRAGE) after release of tourniquet in patients undergoing lower extremity surgery.Methods Sixty patients with unilateral lower extremity operation with tourniquet were randomly divided into control group (n = 30) and experimental group (n = 30).In the test group, the loading dose of dexmetidine was 1 渭 g / kg / kg / L for 15 min, and then 0.5 渭 g / kg / kg / h / h), and the control group was treated by intravenous injection of sodium chloride of equal volume at the same rate.To load the dose pump after the completion of the tourniquet.The incidence of adverse reactions during operation was recorded.Compared with T0, both HMGB1 and sRAGE increased in both groups at T_1~T_4, and in the control group, it was higher than that in the test group.The incidence of bradycardia in the trial group was 17 / 30, which was higher than that in the control group (P 0.05). There was no significant difference in the incidence of nausea and irritability between the two groups.Conclusion the premedication of dexmetomidine can reduce the levels of serum HMGB1 and sRAGE in patients with lower extremity operation after release of tourniquet and alleviate lung injury.
【作者单位】：温州医科大学附属第一医院麻醉科;温州市中西医结合医院麻醉科;
【基金】：浙江省温州市科技计划项目(Y20120213)
【分类号】：R614

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