右美托咪定对腹腔镜胆囊切除术患者炎性反应的影响及机制研究被引量：4

Effects and Mechanism of Dexmedetomidine on Inflammatory Responses in Patients Undergoing Laparoscopic Cholecystectomy

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摘要目的探讨右美托咪定在手术过程中及术后对炎性反应的影响。方法选择腹腔镜手术患者42例,随机分为右美托咪定组(n=21)和对照组(n=21)。在诱导麻醉后,右美托咪定组患者注入起始剂量右美托咪定(1.0μg/kg),然后维持泵入0.2μg/(kg·h)。以同等方法泵入生理盐水作为对照组。比较两组间术中平均动脉压(MAP)和心率(HR)。在4个时间点检测致炎性细胞因子TNF-α和IL-6:麻醉诱导前30min(T0),切皮后10min(T1),腹膜闭合后(T2),术后24h(T3)。在4个时间点同时检测血清C反应蛋白和白细胞计数。结果右美托咪定组在T2时点HR和MAP均低于对照组(P<0.05),右美托咪定组在T2时点HR和MAP均低于T0(P<0.05)。右美托咪定组在T1、T2及T3时点TNF-α和IL-6均低于对照组(P<0.05),对照组在T1、T2及T3时点TNF-α和IL-6均高于T0(P<0.05)。右美托咪定组在T3时点血清C反应蛋白和白细胞计数均低于对照组(P<0.05)。DEX组在T3时点外周血CD4+CD25+CD127low/-T细胞比率高于对照组(P<0.05)。结论右美托咪定的应用减少了术中及术后细胞因子、血清C反应蛋白和白细胞计数的水平。右美托咪定的抗炎效应可能与其维持了炎症及应激状态下CD4+CD25+CD127low/-T细胞的数量有关。 Objective Dexmedetomidine has been shown to reduce pro-inflammatory cytokine levels in severely ill patients.The aim of this study was to document the effects of dexmedetomidine on inflammatory responses during and after surgery.Methods Totally 42 patients undergoing orthopedic surgery were randomly divided into two groups：dexmedetomidine group （n =21） and control group （n =21）.After induction of anaesthesia,patients in the dexmedetomidine group received a loading dose of dexmedetomidine （1.0μg/kg）,followed by infusion of dexmedetomidine at 0.2μg/（kg · h）.A saline-treated group served as a control.Intraoperative mean arterial pressure （MAP）,heart rate （HR） were compared between the groups.The pro-inflammatory cytokines tumour necrosis factor （TNF）-αand IL-6 were quantified by sandwich enzyme-linked immunoassay at four times：at 30 min before anaesthesia induction （To）,at 10 min of operation,at the end of peritoneal closure （T2）,and 24h after surgery （T3）.The C-reactive protein （CRP） level and leukocyte count were also measured at four times.Results At time points T2,the MAP and HR were lower in dexmedetomidine group than in control group （P 〈 0.05）.In dexmedetomidine group,the MAP and HR were lower at time points T2 than at To （P 〈 0.05）.At time points T1,T2 and T3,the TNF-αand IL-6 were lower in dexmedetomidine group than in control group （P 〈 0.05）.In control group,the TNF -αand IL-6 were higher at time points T1,T2 and T3 than at T0 （P 〈 0.05）.At time points T3,the CRP level and leukocyte count were lower in dexmedetomidine group than in control group （P 〈 0.05）.At time points T3,the blood CD4 ＋ CD25 ＋ CD127low/-T cells were higher in dexmedetomidine group than in control group （P 〈 0.05）.Conclusion Dexmedetomidine administration during surgery reduced intraoperative and post-operative secretion of cytokines,as well as leukocyte count and CRP level.The anti-inflammatory effects of dexmedetomidine may may be correlated with the stability of the number of CD4 ＋ CD25 ＋ CD127low/-T cells in inflammatory conditions.

作者李航吕蕾邵军进

机构地区温州医科大学附属东阳医院麻醉科

出处《医学研究杂志》 2014年第10期122-126,共5页 Journal of Medical Research

关键词右美托咪定炎症腹腔镜胆囊切除术 Dexmedetomidine Inflammatory Laparoscopic cholecystectomy

分类号 R9 [医药卫生—药学]

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