右美托咪定对颅脑手术患者围手术期炎性细胞因子的影响

Effect of dexmedetomidine on inflammatory cytokines of patients undergoing cerebral surgery during perioperative period

目的研究右美托咪定(Dex),对颅脑手术患者围手术期炎性反应的影响。方法择期颅脑手术患者40例随机分为对照组和试验组(右美托咪定组),每组20例,试验组在手术开始前30min以右美托咪定0.5μg/kg微泵10min静脉注射,后持续静脉泵注0.2μg/(kg.h)维持至术毕前30min;两组均采用静吸复合全麻,分别于麻醉诱导前、术毕、术后4h和术后24h抽取动脉血,测定血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)和肿瘤坏死因子a(TNF-a)水平。结果试验组术毕、术后4h和术后24h的TNF-a为(25.3±6.5、30.3±7.5、29.3±6.9)pg/ml,IL-6为(27.1±7.4、31.3±8.5、26.3±6.2)pg/ml,IL-8为(10.3±5.5、11.2±5.8、17.4±6.9)pg/ml;较对照组术毕、术后4h和术后24h的TNF-a(30.9±7.7、37.3±8.9、35.3±8.2)pg/ml,IL-6(33.3±8.5、36.3±9.5、31.2±8.1)pg/ml,IL-8(14.3±6.3、15.3±6.5、25.5±8.5)pg/ml,IL-10(31.3±11.5、36.3±13.5、42.3±13.5)pg/ml均明显降低;而IL-10(41.3±12.4、48.3±14.6、55.3±14.8)pg/ml,较对照组IL-10(31.3±11.5、36.3±13.5、42.3±13.7)pg/ml显著升高,两组差异有统计学意义(P<0.01或P<0.05)。结论右美托咪定能减轻颅脑手术患者围手术期炎性反应,在减轻全身炎症反应的同时,也能抑制颅脑手术后促炎性细胞因子的过度诱导,对颅脑手术患者具有脑保护作用。

OBJECTIVE To probe into the effect of dexmedetomidine（Dex） on inflammatory responses to patients undergoing cerebral surgery during perioperative period.METHODS A total of 40 patients receiving selective cerebral surgery were randomly divided into the control group and the study group（dexmedetomidine group） with 20 cases in each group,the study group was given by DEX with support for 0.5 μg/kg using iv-vp for 10 mins at 30 mins before the start of the operation,the amount of support for 0.2 μg/（kg·h） maintained to 30 min before the end of surgery.The operations of the both groups were conducted with inhalation anesthesia.The arterial blood was drawn before anesthesia.induction,at the end of surgery,4 hs of postoperative,and 24 hs of postoperative operation.The serum nterleukin-6（IL-6）,interleukin-8（IL-8）,interleukin-10（IL-10） and tumor necrosis factor a（TNF-a） levels were determined respectively.RESULTS The serum TNF-a of the study group were（25.3±6.5,30.3±7.5,29.3±6.9）pg/ml,IL-6（27.1±7.4,31.3±8.5,26.3±6.2）pg/ml,IL-8（10.3±5.5,11.2±5.8,17.4±6.9）pg/ml,significantly lower than the TNF-a of control group（30.9±7.7,37.3±8.9,35.3±8.2）pg/ml,IL-6（33.3±8.5,36.3±9.5,31.2±8.1）pg/ml,IL-8（14.3±6.3,15.3±6.5,25.5±8.5）pg/ml,IL-10（31.3±11.5,36.3±13.5,42.3±13.5）pg/ml,at the end of surgery,4 hs of postoperative,and 24hs of postoperative operation,however,IL-10 of the study group were（41.3±12.4,48.3±14.6,55.3±14.8）pg/ml which was significantly higher than that of the control group（31.3±11.5,36.3±13.5,42.3±13.7）pg/ml,the differences were statistically significant（P〈0.01 or P〈0.05）.CONCLUSION Dexmedetomidine can reduceinflammatory response to the patients undergoing cerebral surgery during perioperative period,meanwhile,it can inhibit the excessive induction of pro-inflammatory cytokines,thus it takes effect on the protection of the brain for the patients undergoing cerebral surgery.