摘要
目的探讨右美托咪定对老年糖尿病患者炎症反应、心肌损伤及胰岛素抵抗的影响。方法选取2022年7月至2023年4月陕西省人民医院收治的择期行骨科下肢手术治疗的老年糖尿病患者84例进行随机对照试验。采用随机数字表法将其分为观察组和对照组,各42例。观察组男23例,女19例,年龄(71.84±4.01)岁;手术位置:左侧24例,右侧18例。对照组男25例,女17例,年龄(71.44±4.05)岁;手术位置:左侧22例,右侧20例。所有患者均进行静吸复合全身麻醉;观察组麻醉诱导后输注右美托咪定,对照组麻醉诱导后输注等容量生理盐水。比较两组用止血带前(T0)、用止血带后30 min(T1)、松止血带后15 min(T2)、松止血带后60 min(T3)肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、磷酸肌酸激酶同工酶(creatine kinaseisoenzymes,CK-MB)、肌钙蛋白I(cardiac troponin I,cTnI)水平和胰岛素敏感指数(sensitive index,ISI)、拔管时间、ICU停留时间、住院时间。采用t检验和χ^(2)进行统计分析。结果T1、T2、T3时,两组TNF-α、IL-6水平均高于T0时,观察组TNF-α[(26.25±3.36)ng/L比(29.96±4.07)ng/L、(28.25±3.69)ng/L比(34.46±4.42)ng/L、(26.94±3.24)ng/L比(30.05±4.12)ng/L]和IL-6[(318.65±36.63)ng/L比(354.27±41.69)ng/L、(352.45±42.42)ng/L比(414.49±46.68)ng/L、(369.77±45.54)ng/L比(440.52±58.18)ng/L]水平均低于对照组,差异均有统计学意义(t=4.555、6.989、3.845、4.159、6.374、6.205,均P<0.05)。T1、T2、T3时,两组CK-MB、cTnI水平均高于T0时,观察组CK-MB[(26.22±3.25)U/L比(30.11±4.06)U/L、(30.09±3.22)U/L比(48.87±5.52)U/L、(45.54±5.09)U/L比(58.59±6.12)U/L]和cTnI[(0.04±0.02)μg/L比(0.06±0.02)μg/L、(0.08±0.02)μg/L比(0.12±0.03)μg/L、(0.11±0.04)μg/L比(0.22±0.05)μg/L]水平均低于对照组,差异均有统计学意义(t=4.847、19.045、10.624、4.582、7.189、11.133,均P<0.05)。T1、T2、T3时,两组ISI均低于T0时,观察组ISI均高�
Objective To investigate the effect of dexmedetomidine on inflammatory response,myocardial injury,and insulin resistance in elderly patients with diabetes mellitus.Methods Eighty-four elderly diabetic patients taking selective orthopedic lower limb surgical treatment at Shaanxi Provincial People's Hospital from July 2022 to April 2023 were selected for the randomized controlled trial,and were divided into an observation group and a control group by the random number table method,with 42 cases in each group.There were 23 males and 19 females in the observation group;they were(71.84±4.01)years old;24 cases had surgery on the left sides,and 18 the right sides.There were 25 males and 17 females in the control group;they were(71.44±4.05)years old;22 cases had surgery on the left sides,and 20 the right sides.All the patients took intravenous-inhalation combined anesthesia.The observation group took injection of dexmedetomidine after anaesthesia induction,and the control group equal volume of saline.The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),phosphocreatine kinase isoenzymes(CK-MB),and troponin I(cTnI)and insulin sensitive indexes(ISI)before using tourniquets(T0),30 min after using tourniquets(T1),and 15(T2)and 60 min(T3)after loosening tourniquets,extubation times,ICU stays,and hospital stays were compared between the two groups.t andχ^(2) tests were used for the statistical analysis.Results At T1,T2,and T3,the levels of TNF-α,IL-6,CK-MB,and cTnI were higher than those at T0 in both groups;the levels of TNF-α[(26.25±3.36)ng/L vs.(29.96±4.07)ng/L,(28.25±3.69)ng/L vs.(34.46±4.42)ng/L,and(26.94±3.24)ng/L vs.(30.05±4.12)ng/L],IL-6[(318.65±36.63)ng/L vs.(354.27±41.69)ng/L,(352.45±42.42)ng/L vs.(414.49±46.68)ng/L,and(369.77±45.54)ng/L vs.(440.52±58.18)ng/L],CK-MB[(26.22±3.25)U/L vs.(30.11±4.06)U/L,(30.09±3.22)U/L vs.(48.87±5.52)U/L,and(45.54±5.09)U/L vs.(58.59±6.12)U/L],and cTnI[(0.04±0.02)μg/L vs.(0.06±0.02)μg/L,(0.08±0.02)μg/L vs.(0.12±0.03)μg/L,and(0.11±0.04)μg/L vs
作者
张博睿
陈宝余
樊龙
常建华
单冰
刘胜男
Zhang Borui;Chen Baoyu;Fan Long;Chang Jianhua;Shan Bing;Liu Shengnan(Department of Anesthesiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
出处
《国际医药卫生导报》
2024年第23期3996-4000,共5页
International Medicine and Health Guidance News
基金
陕西省重点研发计划(2020SF-154)。
关键词
糖尿病
骨科下肢手术
右美托咪定
止血带
炎症反应
心肌损伤
胰岛素抵抗
Diabetes mellitus
Orthopedic lower limb surgery
Dexmedetomidine
Tourniquet
Inflammatory response
Myocardial injury
Insulin resistance
