Effect of dexmedetomidine on inflammatory response,myocardial injury,and insulin resistance in elderly patients with diabetes mellitus
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 x2 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.
万方数据
维普
