Abstract:

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 and χ² 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. (0.22±0.05) μg/L] in the observation group were lower than those in the control group, with statistical differences (t=4.555, 6.989, 3.845, 4.159, 6.374, 6.205, 4.847, 19.045, 10.624, 4.582, 7.189, and 11.133; all P<0.05). At T1, T2, and T3, the ISI's were lower than those at T0 in both groups; the ISI's in the observation group were higher than those in the control group (0.006±0.002 vs. 0.004±0.001, 0.004±0.001 vs. 0.002±0.001, and 0.011±0.005 vs. 0.004±0.001), with statistical differences (t=5.796, 9.165, and 8.896; all P<0.05). The extubation time, ICU stay, and hospital stay in the observation group were shorter than those in the control group [(2.75±0.62) h vs. (4.19±0.94) h, (16.88±2.27) h vs. (22.26±3.63) h, and (15.22±2.63) d vs. (20.19±4.46) d], with statistical differences (t=8.287, 8.143, and 6.220; all P<0.05). Conclusion　Pretreatment with dexmedetomidine in orthopedic lower limb surgery for elderly diabetic patients can inhibit their inflammatory response and oxidative stress, reduce tourniquet-related myocardial injury, control blood glucose and insulin resistance, and promote their postoperative recovery, so it is worthy of promotion.

Key words:

Diabetes mellitus, Orthopedic lower limb surgery, Dexmedetomidine, Tourniquet, Inflammatory response, Myocardial injury, Insulin resistance

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χ²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均高于对照组（0.006±0.002比0.004±0.001、0.004±0.001比0.002±0.001、0.011±0.005比0.004±0.001），差异均有统计学意义（t=5.796、9.165、8.896，均P<0.05）。观察组拔管时间、ICU停留时间、住院时间均短于对照组［（2.75±0.62）h比（4.19±0.94）h、（16.88±2.27）h比（22.26±3.63）h、（15.22±2.63）d比（20.19±4.46）d］，差异均有统计学意义（t=8.287、8.143、6.220，均P<0.05）。结论　老年糖尿病患者行骨科下肢手术中采用右美托咪定预处理可抑制炎症反应和氧化应激反应，减轻止血带性心肌损伤，控制血糖及胰岛素抵抗，促进术后快速恢复，值得推广。

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