右旋美托咪啶对围术期炎症介质及外周血单核细胞NF-κB的影响

Effects of dexmedetomidine on the production of tumor necrosis factor-α and interleukin-6 and the activation of nuclear factor kappaB

目的探讨右旋美托咪啶的抗炎作用及其对外周血单核细胞NF-κB活性的影响。方法选择20~70岁ASAⅠ~Ⅱ行择期腰椎手术病人60例,随机分为右旋美托咪啶对照组（Ⅰ组）、0.5 μg组（Ⅱ组）、1.0 μg组（Ⅲ组）。选择气管内插管全身麻醉,分别于麻醉诱导后手术开始前（T1）、手术结束前半小时（T2）、术后24 h（T3）抽取静脉血,用ELISA法测定血浆中的IL-6、TNF-α的浓度,用流式细胞仪测量外周血单核细胞NF-κB活性的表达。结果三组患者术中芬太尼用量Ⅰ组（0.90±0.72）mg,Ⅱ组（0.71±0.58）mg,Ⅲ组（0.65±0.05）mg,瑞芬太尼用量Ⅰ组（1.35±0.80）mg,Ⅱ组（1.15±0.74） mg,Ⅲ组（1.02±0.70） mg和术后镇痛芬太尼使用剂量Ⅰ组（0.98±0.37）mg,Ⅱ组（0.84±0.19）mg,Ⅲ组（0.55±0.16）mg的差异具有统计学意义（P〈0.05）,三组患者血浆IL-6、TNF-α以及外周血单核细胞NF-κB的活性组间差异无统计学意义（P〉0.05）。结论在行腰椎手术的麻醉中使用右旋美托咪啶可以减少阿片类药物用量。右旋美托咪啶定可以作为腰椎手术的麻醉的辅助药。右旋美托咪啶对IL-6、TNF-α以及外周血单核细胞NF-κB的表达没有明显影响。

Objective To investigate the effects of dexmedetomidine on activation of nuclear factor kappaB（NF-κB） in human peripheral monocytes and production of tumor necrosis factor-α（TNF-α） and Interleukin-6 （IL-6）. Methods 60 patients aged 20-70 years, ASA I-II. The subjects were randomly divided into three groups： Ⅰ（control group）, Ⅱ （0.5μg group）, Ⅲ （1.0μg group）, and every group had 20 cases. GroupⅠdid not use dexmedetomidine; Group Ⅱ received IV dexmedetomidine 0.5 μg/kg over 10 minutes before anaesthesia and a continuous infusion dose of 0.5 μg/（kg·h） during operation; Group Ⅲ received IV dexmedetomidine 0.5 μg/kg over 10 minutes before anaesthesia and a continuous infusion dose of 1.0μg/（kg·h） during operation. Mean arterial pressure （MAP）, heart rate （HR）, peripheral oxygen saturation （SpO2） at T1（before anesthesia）, T2（30min before the end of surgery）, T3（24h after surgery）were recorded, and concentrations of IL-6, TNF-α were measured. The NF-κB p65 expression in monocytes was determined by flow cytometry. Results The operative fentanyl requirements were significantly lower in Group Ⅱ（0.71±0.58）mg, Ⅲ（0.65±0.05）mg than that in GroupⅠ（0.90±0.72）mg （P0.05）. The operative remifentanyl requirements were significantly lower in Group Ⅱ（1.15±0.74） mg, Ⅲ（1.02±0.70） mg than that in GroupⅠ（1.35±0.80）mg （P0.05） and the postoperative dosages of fentanyl had significant differences in three groups, as Group Ⅲ（0.55±0.16）mg, Group Ⅱ（0.84±0.19）mg, GroupⅠ（0.98±0.37）mg. But there were no significant difference in the activation of NF-κB in human peripheral monocytes and the production of TNF-α and IL-6. Conclusion Dexmedetomidine seems to be an effective adjunct to anesthetic agents during major elective lumbar spine surgery. Dexmedetomidine can reduce the usage of opioids during perioperative. Dexmedetomidine seems have little effects in the activation of NF-κB in human peripheral monocytes and the production of TNF-α and IL-6.