| Objective:To observe the therapeutic effect of butorphanol and dexmedetomidine on the ischemia-reperfusion injury of the body and evaluate its clinical application value,in order to provide more theoretical and practical basis for future clinical work.Methods: Sixty patients(18 to 65 years old)who underwent elective lower extremity surgery and required a tourniquet were enrolled in our hospital.The ASA grade was grade I or II.Randomized digital table method was used to randomly divide patients into control group(group C),dexmedetomidine group(group D),butorphanol group(group B),butorphanol+ dexmedetomidine group(group B+D),15 cases in each group.All patients underwent surgical treatment under lumbar-hard anesthesia,and the anesthesia plane was controlled below T10.Before anesthesia,the first blood was drawn,and no treatment was given in group C.In group D,the dexmedetomidine loading dose was 0.6ug/kg,and after 10 minutes of continuous pumping,the maintenance dose was changed to 0.4ug/kg till the end of the operation;group B was slowly injected with 0.02 mg/kg butorphanol;group B+D was slowlyinjected with 0.02 mg/kg butorphanol,and dexmedetomidine pump was injected at the same time,the pumping method was the same as group D.The HR,MAP,and SpO2 of the patients in the group were tested at T0(before anesthesia),T1(before the upper tourniquet),T2(before the loose tourniquet),T3(10 minutes after the loose tourniquet),and T4(30 minutes after the loose tourniquet).And the venous blood at three time points of T0,T3,and T4 was taken to detect serum MDA,SOD,and TNF-?.Adverse reactions were observed within 24 hours after surgery.Result:1.Comparison of general data: There were no significant differences in age,body mass index,duration of tourniquet use,and gender between the four groups(P>0.05).2.Comparison of serum MDA concentrations in four groups ofpatients:(1)Comparison within the group: Compared with T0,the serum MDA concentration of the four groups increased at T3 and T4,and the difference was statistically significant(P<0.05).(2)Comparison between groups: At T0,there was no significant difference in serum MDA concentration between the four groups(P>0.05).At T3 and T4,the serum MDA concentration in group D,B and B+D was significantly higher than that in group C.The difference was statistically significant(P<0.05).However,there was no significant difference in serum MDA concentration between group D and group B,group D and group B+D,group B and group B+D(P>0.05).3.Comparison of serum SOD concentrations in four groups of patients:(1)Comparison within the group: Compared with T0,the serum SOD concentration of the four groups decreased at T3 and T4,and the difference was statistically significant(P<0.05).(2)Comparison between groups: There was no significant difference in serum SOD concentration between the four groups at T0(P>0.05).At T3 and T4,serum SOD concentrations in group D,B and B+D were significantly higher than those in group C.The difference was statistically significant(P<0.05).However,there was no significant difference in serum SOD concentration between group D and group B,group D and group B+D,group B and group B+D(P>0.05)..4.Comparison of serum TNF-? concentrations in four groups of patients:(1)Comparison within the group: Compared with T0,the serum TNF-?concentration of the four groups increased at T3 and T4,and the difference was statistically significant(P<0.05).(2)Comparison between groups: At T0,there was no significant difference in serum TNF-? concentration between the four groups(P>0.05).At T3 and T4,serum TNF-? concentration in group D,B and B+D patients Compared with group C,the difference was statistically significant(P<0.05).However,there was no significant difference in serum TNF-? concentration between group D and group B,group D and group B+D,group B and group B+D.(P>0.05).5.Four groups of patients at various time points of vital signs(1)Comparison within the group: Compared with T0,HR and MAP of group C and group B decreased at T1-T4,but the difference was not statistically significant(P>0.05).HR of group D and group B+D,MAP decreased significantly at T1-T4,and the difference was statistically significant(P<0.05).Compared with T0,there was no significant difference in SpO2 between the four groups at T1-T4(P>0.05).(2)Comparison between groups: Compared with group C,HR,MAP,and SpO2 in group D,group B,and group B+ were not significantly different at T0-T4(P>0.05).6.Comparison of adverse reactions within 24 hours after surgery in four groups of patients:Compared with group C,group B and group B+D,the number of cases of bradycardia was significantly increased in group D,the difference was statistically significant(P<0.05);group B was compared with group C,group D and group B+D.The incidence of nausea and vomiting increased,and the difference was statistically significant(P<0.05).Inconclusion:Butorphanol can reduce oxidative stress and inflammatory response induced by ischemia-reperfusion after tourniquet.Its combination with dexmedetomidine can also reduce oxidative stress and inflammatory response induced by ischemia-reperfusion after tourniquet,and compared with dexmedetomidine and butorphanol alone,it did not produce a superposition,but the incidence of nausea,vomiting and bradycardia wassignificantly reduced within 24 hours after surgery. |
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