右美托咪啶预处理对下肢缺血再灌注致肺损伤的保护作用
于健;李睿;姚文瑜
【期刊名称】《中华医学杂志》 【年(卷),期】2014(000)044
【摘要】Objective To investigate the effects of dexmedetomidine preconditioning attenuating remote lung injury of lower limb ischemia-reperfusion.Methods Sixty patients form Central Hospital of Cangzhou scheduled for lower limb operation with tourniquet from January 2014 to June 2014.Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups .All patients were randomly assigned to two groups , conventional general anesthesia group ( R group, n =30 ) and dexmedetomidine preconditioning group ( Pre-Dex group, n =30 ) . In the group Pre-Dex, a dexmedetomidine intravenous infusion was started at a dose of 0.125 ml/kg(4μg/ml) for 10 minutes before using tourniquet , whereas group R received an equivalent volume of normal saline .Blood samples were taken in femoral vein for 4 ml.Monocytes TLR4 expression and interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor-α( TNF-α) level were determinated 15 minute before tourniquet inflation ( T1 ) , 15 minute (T2), 2 h(T3), 6 h(T4)and 24 h(T5) after tourniquet release.Artery blood gas analysis,respiratory index and oxygenation index were measured by drawing off femoral artery for 2 ml.Results Compare with
T1 , RI in group R was higher at T 4 and OI was lower at T 3-5 ( P<0.01) ,and there were no significant differences in group Pre-Dex at T2 -T5 about RI and OI(P>0.05);IL-8,IL-6 level at T3 -T5 and TNF-αlevel at T2 -T5 in group R were significantly higher .IL-8,IL-6 level at T3 -T4 and TNF-αlevel at T2 -T4 in group Pre-Dex were higher.Monocytes TLR4 expression was higher in group R at T 3 -T4(P<0.05).Compare with group R, RI in group Pre-Dex was lower and OI was higher at T4 (P<0.05); IL-8,IL-6 level at T3 -T5 and TNF-αlevel at T2 -T4 in group Pre-Dex was significantly lower(P<0.05).Monocytes TLR4 expression was lower in group Pre-Dex at T3 -T5(P<0.05).IL-6,IL-8 level had positive correlation with TLR4 and RI ((r=0.673,0.647,0.521,0.457, P <0.01 ),but had negative correlation with OI in group R (r =-0.613,-0.578,P<0.01).Conclusion Dexmedetomidine preconditioning attenuate remote lung injury of lower limb ischemia-reperfusion, and the mechanism may be related to down-regulation of monocytes TLR4 expression and degradation of IL-6, IL-8 and TNF-αlevel.%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致肺损伤的保护作用。方法选取沧州市中心医院2014年1至6月期间60例拟行骨科下肢手术的患者，所有患者均在神经刺激仪定位下行腰丛－坐骨神经联合阻滞麻醉后手术。将患者随机分为对照组（ R组，n＝30）和右美托咪啶预处理组（ Pre－Dex 组， n ＝30）。 Pre－Dex 组于上止血带前15 min 静脉泵注右美托咪啶0．125 ml／kg（4μg／ml），10 min内泵注完；R组在相应时间点给予等量生理盐水。在
上止血带之前15 min（ T1）以及松止血带后15 min（ T2）、2 h（ T3）、6 h（ T4）、24 h（ T5）于股静脉抽取静脉血4 ml分别测量单核细胞Toll样受体4（TLR4）表达、白细胞介素－6（IL－6）、白细胞介素－8（IL－8）、肿瘤坏死因子－α（TNF－α）浓度。同时经股动脉抽取动脉血2 ml，测定血气分析，计算呼吸指数（RI）、氧合指数（OI）。结果与T1比较，R组T4时RI升高，T3～5时OI降低（P＜0．01），Pre－Dex组各时点RI、OI指标比较差异无统计学意义（ P＞0．05）；R组T3～T5时IL－6、IL－8浓度升高，T2～T5 TNF－α浓度升高，Pre－Dex组T3～T4时IL－6、IL－8浓度升高，T2～T4 TNF－α浓度升高；R组在T3～T4时单核细胞TLR4表达升高（P＜0．05）。与R组比较，Pre－Dex组在T4时RI降低、OI升高（P＜0．05）；Pre－Dex组在T3～T5时IL－6、IL－8浓度与T2～T4时TNF－α浓度明显减少（ P＜0．05）；Pre－Dex组在T3～T5时单核细胞TLR4表达下调（P＜0．05）。 R组患者血浆IL－6、IL－8水平与RI值呈正相关（r＝0．521、0．457，P＜0．01），与TLR4表达呈正相关（r＝0．673、0．647，P＜0．01），与OI值呈负相关（r＝－0．613、－0．578，P＜0．01）。结论右美托咪啶预处理对止血带引起的肢体缺血再灌注致肺损伤有一定的保护作用，可能是通过降低单核细胞TLR4的表达，减少IL－6、IL－8和TNF－α的分泌来实现。 【总页数】5页(3510-3514)
【关键词】右美托咪啶;缺血再灌注;肺损伤;炎性细胞因子 【作者】于健;李睿;姚文瑜
【作者单位】061001 河北省沧州市中心医院麻醉一科;061001 河北省沧州市中心医院麻醉一科;061001 河北省沧州市中心医院麻醉一科
右美托咪啶预处理对下肢缺血再灌注致肺损伤的保护作用
