右美托咪定对腹股沟嵌顿性疝致肠缺血-再灌注损伤手术老年患者肝肾功能的保护及影响

doi:10.3969/j.issn.1004-583X.2021.08.012

摘要/Abstract

摘要：

目的分析右美托咪定对腹股沟嵌顿性疝手术老年患者肝、肾功能、促炎因子的影响以及临床疗效。方法美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级的老年腹股沟嵌顿性疝患者60例,随机分成对照组和试验组。两组患者均术前禁食水且在硬膜外麻醉下行无张力疝修补手术,试验组入室后即给右美托咪定静脉泵注[0.3 μg/(kg·h)],对照组以同样的速度泵注生理盐水。所有患者分别于术前及术后第1天清晨空腹取远端静脉血测定肝、肾功能包括丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、肌酐(Cre)及血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、白介素-8(IL-8)和瘤坏死因子-α(TNF-α)水平。结果术后试验组患者肝、肾功能指标及CRP、IL-6、IL-8、TNF-α水平显著低于对照组(均P<0.05)。结论右美托咪定对老年腹股沟嵌顿性疝手术患者肝、肾功能有保护作用,其机制可能与右美托咪定能减轻肠缺血-再灌注损伤所致的炎症反应有关。

关键词: 右美托咪定, 疝,腹股沟, 肝功能试验, 肾功能试验, 炎症因子类

Abstract:

Objective To investigate the clinical effect of dexmedetomidine on liver and kidney function and proinflammatory cytokines of incarcerated inguinal hernia in the elderly surgical patients. Methods Sixty elderly patients with incarcerated inguinal hernia, who met American Society of Anesthesiologists(ASA) Classification Ⅰ-Ⅱ, were randomly divided into experimental group and control group. All patients were preoperative fasting water and food and had a tension-free hernia repair under epidural anesthesia. Patients of experimental group received a pumping injection of dexmedetomidine at a rate of 0.3 μg/(kg·h). Patients of control group received a pumping injection of normal saline at the same rate. The venous blood sampled before operation and the first day after the operation were used to assay the liver and kidney function including alanine transaminase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN), creatinine(Cre) and serum C-reactive protein(CRP), interleukin-6(IL-6), IL-8 and tumor necrosis factor-α(TNF-α) levels. Results Hepatic and kidney function-related indicators and CRP, IL-6, IL-8, TNF-α after operation were significantly lower in experimental group than in control group (P<0.05 or 0.01). Conclusion Dexmedetomidine has protective effects on liver and renal function for elderly surgical patients with incarcerated inguinal hernia, and the mechanism may be related to the reduction of inflammatory response caused by intestinal ischemia and reperfusion injury.

Key words: dexmedetomidine, hernia,inguinal, liver function tests, kidney function tests, chemokines

中图分类号:

R656.21

郑紫磊, 杨延江, 李海英. 右美托咪定对腹股沟嵌顿性疝致肠缺血-再灌注损伤手术老年患者肝肾功能的保护及影响[J]. 临床荟萃, 2021, 36(8): 735-738.

Zheng Zilei, Yang Yanjiang, Li Haiying. Protection and effect of dexmedetomidine on liver and kidney function of incarcerated inguinal hernia caused intestinal ischemia and reperfusion injury in the elderly surgical patients[J]. Clinical Focus, 2021, 36(8): 735-738.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.08.012

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I8/735

图/表 3

参考文献 13

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组别	例数	性别(例)		年龄 (岁)	BMI (kg/m²)	手术时间 (min)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	手术时间 (min)
对照组	30	16	14	67.1±5.8	23.5±1.5	81.6±8.9
试验组	30	18	12	65.9±5.2	22.3±1.6	82.3±7.9
统计值		0.347		0.068	0.038	0.0569
P值		0.128		0.795	0.861	0.476

组别	例数	性别(例)		年龄 (岁)	BMI (kg/m²)	手术时间 (min)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	手术时间 (min)
对照组	30	16	14	67.1±5.8	23.5±1.5	81.6±8.9
试验组	30	18	12	65.9±5.2	22.3±1.6	82.3±7.9
统计值		0.347		0.068	0.038	0.0569
P值		0.128		0.795	0.861	0.476

组别	例数	AST(U/L)		ALT(U/L)		BUN(mmol/L)		Cre(μmol/L)
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
对照组	30	28.12±9.47	41.12±12.47^*	35.16±5.64	45.16±13.64^*	4.25±0.92	12.63±1.92^*	74.31±6.23	91.11±43.25^*
试验组	30	27.89±7.64	35.39±11.64^*	34.45±8.37	38.45±12.37^*	4.39±0.86	7.99±1.97^*	74.69±13.71	80.02±29.71^*
t值		1.773	13.287	4.076	12.18	0.781	14.218	4.074	24.298
P值		0.879	0.026	0.737	0.034	0.396	0.006	0.743	0.022

组别	例数	AST(U/L)		ALT(U/L)		BUN(mmol/L)		Cre(μmol/L)
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
对照组	30	28.12±9.47	41.12±12.47^*	35.16±5.64	45.16±13.64^*	4.25±0.92	12.63±1.92^*	74.31±6.23	91.11±43.25^*
试验组	30	27.89±7.64	35.39±11.64^*	34.45±8.37	38.45±12.37^*	4.39±0.86	7.99±1.97^*	74.69±13.71	80.02±29.71^*
t值		1.773	13.287	4.076	12.18	0.781	14.218	4.074	24.298
P值		0.879	0.026	0.737	0.034	0.396	0.006	0.743	0.022

组别	例数	CRP(mg/L)		IL-6(pg/ml)		IL-8(ng/ml)		TNF-α(pg/ml)
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
对照组	30	8.12±1.47	10.12±1.47^*	476.16±33.64	576.16±33.64^*	8.63±1.92	9.54±1.92^*	5.76±2.23	7.81±2.39^*
试验组	30	8.39±1.64	7.39±1.64^*	478.45±32.37	378.45±32.37^*	8.99±1.97	7.12±1.97^*	5.87±2.21	6.72±2.21^*
t值		0.783	4.379	32.359	267.41	1.227	7.479	1.414	3.762
P值		0.645	0.023	0.846	0.000	0.734	0.002	0.674	0.036