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目的 观察右美托咪定预处理对下肢手术患者止血带松开后高迁移率族蛋白1 (HMGB1)和可溶性晚期糖基化终末产物受体(sRAGE)水平的影响.方法 择期应用止血带行单侧下肢手术患者60例,均行腰硬联合麻醉,随机分为对照组和试验组,每组30例.试验组静脉泵注右美托咪定负荷剂量1 μg·kg-1,15 min完成,随后以0.5 μg·kg-1·h-1静脉泵注至术毕;对照组以相同速率静脉泵注等容量氯化钠注射液.待负荷剂量泵注完成后上止血带.于扎止血带前(T0),松止血带后30 min (T1)、2 h(T2)、6h(T3)和24 h(T4)时抽取桡动脉血行血气分析,留取血清检测HMGB1和sRAGE浓度.记录术中不良反应的发生情况.结果 与T0时比较,T3时两组动脉氧分压(PaO2)均降低(P＜0.05),肺泡气-动脉血氧分压差(PA-aO2)和呼吸指数(RI)均升高(P＜0.05);T3时试验组PaO2高于对照组(P＜0.05),PA-aO2和RI低于对照组(P＜0.05).与T0时比较,两组患者T1～T4时HMGB1和sRAGE均升高(P＜0.05),对照组高于试验组(P＜0.05).试验组心动过缓发生率17％ (5/30),高于对照组(P＜0.05),恶心、烦躁等发生率组间无显著差异.结论 右美托咪定预先给药可降低下肢手术患者止血带松开后血清HMGB1和sRAGE水平,减轻肺损伤.“,”AIM To investigate the effects of dexmedetomidine preconditioning on serum levels of high mobility group box 1 protein (HMGB1) and soluble receptor of advanced glycosylation end products (sRAGE) in patients undergoing lower extremity surgery with tourniquet application.METHODS Sixty scheduled for unilateral lower limb surgery patients undergoing spinal-epidural anesthesia were randomly divided into control group (n =30) and trial group (n =30).Dexmedetomidine intravenous infusion was started with a loading dose of 1 μg·kg-1 in 15 minutes by intravenous injection pump for the patients in the trial group,then following by 0.5 μg ·kg-1 ·h-1 to the end of surgery.The patients in the control group were administrated same amount of chloride sodimn injection by intravenous injection pump.Tourniquet was inflated when the loading dose dexmedetomidine and chloride sodiun of both groups were completely infused.The radial artery blood samples were obtained for gas analysis and measurement of HMGB1 and sRAGE at five time points:before tourniquet inflation (T0),30 min after tourniquet release (T1),2 h after tourniquet release (T2),6 h after tourniquet release (T3),24 h after tourniquet release (T4).The adverse reactions during the operation were recorded.RESULTS Compared with those at T0,the PaO2 levels of both groups significantly decreased at T3 (P ＜ 0.05),the PA-aO2 levels and respiratory index (RI) of both groups significantly increased at T3 (P ＜ 0.05).Compared with those in the control group,the PaO2 levels of the trial group significantly increased (P ＜ 0.05) at T3,the PASO2 levels and RI significantly decreased at T3 (P ＜ 0.05).Compared with those at T0,the serum concentrations of HMGB1 and sRAGE at T1,T2,T3,T4 were significantly increased in both groups (P ＜ 0.05).The serwm concentrations of HMGB1 and sRAGE at T1,T2,T3,T4 in the trial group were significantly lowerthan those in the control group (P ＜ 0.05).The incidence rate of bradycardia in the trial group was 17％ (5/30),which was higher than that in the control group (P ＜ 0.05).There was no significant difference in the incidence of vomiting,dysphoria,tachycardia and hypotension between the two groups.CONCLUSION Dexmedetomidine used in advance can protect the lung against ischemia-reperfusion by reducing levels of HMGB1 and sRAGE after tourniquet release in lower extremity surgery patients.