摘要
目的研究右美托咪定对烧伤脓毒症患者肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)、白细胞介素6(IL-6)及血气分析指标的影响。方法选取2015年1月-2017年1月于该院选择择期手术治疗的烧伤脓毒症患者50例。根据随机数字表分为观察组及对照组(各25例)。所有患者均行常规麻醉诱导,观察组患者于麻醉诱导前15 min静脉输注右美托咪定0.3μg/kg,且在手术过程中以0.3μg/(kg·h)速率持续输注。对照组患者则给予等量生理盐水输注。分别比较不同时间两组患者的血压、心率(HR)、动脉血气分析指标水平、静脉血TNF-α、NF-κB、IL-6水平以及住院时间、28 d病死率。结果两组患者T1、T2、T3及T4时的平均动脉压(MAP)、HR差异无统计学意义(P>0.05)。两组T1、T2、T3、T4时的血清TNF-α、NF-κB、IL-6水平比较,采用重复测量设计的方差分析:(1)不同时间TNF-α、NF-κB、IL-6水平有差异(F=13.322、5.362和21.457,P=0.000、0.034和0.000);(2)两组血清TNF-α、NF-κB、IL-6水平有差异(F=11.472、16.813和14.195,均P=0.000),观察组血清TNF-α、NF-κB、IL-6水平均低于对照组;(3)两组血清TNF-α、NF-κB、IL-6的变化趋势有差异(F=14.623、4.974和17.765,P=0.000、0.038和0.000)。两组T1、T2、T3、T4时的血氧分压(Pa O)2、动脉血二氧化碳分压(Pa CO)/2吸入气中的氧浓度分数(Fi O)水平比较,采用重复测量设计的方差分析:(1)不同时间2Pa O2、Pa CO2/Fi O2水平有差异(F=15.382和17.367,均P=0.000);(2)两组的Pa O2、Pa CO2/Fi O2水平有差异(F=9.276和12.343,均P=0.000),观察组均高于对照组;(3)两组的Pa O2、Pa CO2/Fi O2水平变化趋势有差异(F=9.156和10.485,均P=0.00)。观察组住院时间为(8.3±1.4)d,低于对照组的(9.3±1.5)d,差异有统计学意义(P<0.05)。结论右美托咪定应用于烧伤脓毒症患者手术中可有效维持术中循环稳定,具有一定的肺保护作用,有利于促进患者早日康复,值得临床推广应用。
Objective To explore the effect of Dexmedetomidine on TNF-α, nf-kappaB （NF-κB）, IL-6and blood gas analysis index of burn patients with sepsis. Methods A total of 50 burn patients with sepsisreceiving selective operation were selected from January 2015 to March 2017. They were divided intoobservation group and control group according to random number table, each group included 25 cases. All thepatients received general anesthesia induction, the observation group was given Dexmedetomidine 0.3 μg/kg by intravenous infusion 15 min before anesthesia induction, and 0.3 μg/（kg·h） by intravenous infusion during theoperation. The control group was given normal saline at the same dosage. Blood pressure, heart rate （HR）,arterial blood gas analysis index, the level of TNF-α, NF-κB and IL-6 in venous blood, hospital stay and28-day fatality rate were compared between the two groups at different time points. Results The MAP andHR atT1,T2,T3 andT4 were no difference between two groups（P〉 0.05）. the levels of TNF-α, NF-κB, IL-6at different time points were significantly different（ = 13.322, 5.362 and 21.457; = 0.000, 0.034 and 0.000）,the levels of TNF-α, NF-κB, IL-6 were different between two groups（ = 11.472, 16.813 and 14.195; all =0.000）, the levels of TNF-α, NF-κB, IL-6 observation group were lower than the control group. the changetrends of TNF-α, NF-κB, IL-6 were significantly different （ = 14.623, 4.974 and 19.765; F= 0.000, 0.038and 0.000）. the levels of PaO2, PaCO2/FiO2 at different time points were different （ = 15.382, 17.367; all =0.000）. The levels of PaO2, PaCO2/FiO2 were significantly different between two groups （ F= 9.276, 12.343; all= 0.000）, the observation group were higher than the control group, the change trends of PaO2, PaCO2/FiO2levels in two groups were significantly different （ =9.156, 10.485; F= 0.000）. The hospital stay in theobservation group （8.3 ± 1.4） d was significantly lower than the control group （9.3 ± 1.5）d （P〈 0.05）.Conclusions Dexmedetomidine improves the balance of hemodynamics during the operation in burn patientswith sepsis, acting an effective protection to lung tissue, which is worthy of clinical popularization andapplication.
出处
《中国现代医学杂志》
CAS
北大核心
2017年第30期88-92,共5页
China Journal of Modern Medicine
基金
广东省梅州市科学技术局审批项目(No:2016B041)
关键词
烧伤脓毒症
右美托咪定
炎症因子
肺功能
血气分析
burn sepsis
Dexmedetomidine
inflammation factors
lung function
blood gas analysis
