右美托咪定对创伤失血性休克患者炎症因子、肾功能及血流动力学的影响

Effects of dexmedetomidine on inflammatory response and renal function in Patients with Traumatic Hemorrhagic Shock

目的探讨右美托咪定对创伤失血性休克(traumatic hemorrhagic shock,THS)患者炎症因子、肾功能及血流动力学的影响。方法选择2015年3月—2017年4月在温岭市中医院诊治的THS患者90例,按照随机数字表法将其分为观察组(45例)和对照组(45例),观察组与对照组分别于麻醉诱导后切皮前给予等量的右美托咪定和生理盐水,分别于切皮前即刻(T1)、术毕即刻(T2)、术毕1 d(T3)、术毕3 d(T4)比较2组炎症因子、肾功能及血流动力学指标的变化情况。结果 T2时刻,2组炎症因子水平均明显低于T1时刻(均P <0. 05),T3时刻,2组炎症因子水平均明显高于T1时刻(均P <0. 05),且观察组△HMGB1明显低于对照组(P <0. 05); T2～T4时刻,2组Scr水平明显低于T1时刻(均P <0. 05),且观察组△Scr明显高于对照组(P <0. 05); T2时刻,2组NGAL水平明显高于T1时刻(P <0. 05),T3～T4时刻,2组NGAL水平相比于T1、T2时刻明显降低(均P <0. 05),且观察组△NGAL与对照组相比更高(P <0. 05);观察组CVP、MAP以及HR水平改善程度好于对照组(均P <0. 05)。结论右美托咪定可明显降低THS患者的炎症反应,有利于患者肾功能的恢复以及血流动力学水平的稳定。

Objective To investigate the effect of dexmedetomidine on inflammatory factors,renal function and hemodynamics in patients with traumatic hemorrhagic shock( THS). Methods A total of 90 patients with THS diagnosed and treated in our hospital from March 2015 to April 2017 were randomly divided into observation group( 45 cases) and control group( 45 cases) according to the random number table method,the observation group and the control group were given the same amount of dexmedetomidine and normal saline after the induction of anesthesia,the changes of the inflammatory index,renal function and hemodynamics were compared between the two groups before beginning of surgery( T1),immediately after surgery( T2),1 day after syrgery( T3) and three days after surgery( T4). Results At the time of T2,the levels of inflammatory factors in the two groups were significantly lower than those of T1( all P < 0. 05),at the time of T3,the levels of inflammatory factors in the two groups were significantly higher than those of T1( all P < 0. 05),and the△HMGB1 of the observation group was significantly lower than that of control group( P <0. 05);At the time of T2 to T4,the level of the Scr of the two groups were significantly lower than that of T1( all P < 0. 05),and the △Scr of the observation group was significantly higher than that of control group( P < 0. 05). At the time of T2,the level of NGAL in the two groups were significantly higher than that of T1( P < 0. 05),at the time of T3 to T4,the level of the NGAL of the two groups were significantly lower than that of T1 and T2( all P < 0. 05),and the △NGAL of the observation group was significantly higher than that of control group( P < 0. 05). The improvement of CVP,MAP and HR in the observation group were better than that in the control group( all P < 0. 05). Conclusion Dexmedetomidine can significantly reduce the inflammatory response in patients with THS,which is conducive to the recovery of renal function and the stability of hemodynamic level in patients.