前列地尔联合右美托咪定预处理对骨骼肌缺血再灌注和继发性肺损伤保护的研究

发布时间：2018-01-21 12:31

本文关键词： 右美托咪定前列地尔预处理再灌注损伤肺损伤　出处：《重庆医学》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨前列地尔联合右美托咪定预处理对骨骼肌缺血再灌注和继发性肺损伤的保护作用。方法选择行单侧下肢手术患者60名,年龄小于70岁,随机分为对照组(A组),右美托咪定组(B组)、前列地尔组(C组)、联合用药组(D组)4组,每组15例。C组和D组于止血带加压前15min分别从静脉滴入前列地尔10μg,B组和D组于止血带加压前10min从静脉滴入右美托咪定1μg/kg,A组滴入等量生理盐水。分别于吸氧前(T1)、松止血带后2h(T2)、松止血带后6h(T3)采集动脉血和静脉血用于血气分析及丙二醛(MDA)、人肺泡表面活性特异蛋白D(SP-D)的测量。结果 T2时刻B、C组和D组的肺泡动脉氧分压差(PA-aDO2)和呼吸指数(RI)均明显低于A组(P0.05),T3时刻各组PA-aDO2及RI均高于T1时刻(P0.05);T2和T3时刻B、C及D组MDA及SP-D均明显低于A组(P0.05);T3时刻D组MDA及SP-D均明显低于B、C组(P0.05)。结论静脉注射前列地尔及右美托咪定对患者进行预处理能够明显减少骨骼肌缺血再灌注损伤及由此而引起的继发性肺损伤,二者联合应用作用更强。
[Abstract]:Objective to investigate the protective effect of alprostadil combined with dexmetidine on skeletal muscle ischemia reperfusion and secondary lung injury. They were randomly divided into control group (group A), dexmetomidine group (group B), alprostadil group (group C) and combination group (group D). In each group, 15 cases in group C and group D received 10 渭 g prostadil from vein 15 minutes before tourniquet compression. Group B and group D received the same amount of normal saline 10 minutes before the tourniquet compression. The same amount of normal saline was dripped into group A (1 渭 g 路kg ~ (-1) 路kg ~ (-1) 路L ~ (-1)) before inhalation of oxygen, and 2 h after releasing tourniquet. Arterial and venous blood samples were collected 6 hours after tourniquet for blood gas analysis and measurement of malondialdehyde (MDA) MDAA, human alveolar surfactant specific protein (DS-SP-D). The pulmonary alveolar arterial oxygen pressure difference (PA-aDO2) and respiratory index (RI) in group C and D were significantly lower than those in group A (P 0.05). The PA-aDO2 and RI in T3 group were higher than that in T1 time group (P 0.05). The MDA and SP-D of group B C and D were significantly lower than those of group A at T 2 and T 3; MDA and SP-D in group D were significantly lower than those in group B. Conclusion intravenous preconditioning of alprostadil and dexmetomidine can significantly reduce skeletal muscle ischemia-reperfusion injury and secondary lung injury. The combined application of the two is more powerful.
【作者单位】：包头医学院第二附属医院麻醉科;内蒙古自治区包头市第四医院麻醉科;
【基金】：社会发展科技支撑项目(2014S2003-4-3)
【分类号】：R614
【正文快照】： 止血带为临床骨科手术中常用的手术器械,但其引起的术中肢体的短暂缺血可造成肢体组织的缺血再灌注损伤,且常常可造成远隔器官的损伤,其中肺脏是出现较早而且较重的受累器官[1],右美托咪定是新型的α2受体激动剂,临床发现通过静脉注射后对组织的缺血再灌注有保护作用,研究者认

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