右旋美托咪啶镇静治疗对严重创伤后炎症因子的影响

Effect of sedation by infusion of dexmedetomidine on inflammatory factors in patients with severe trauma

目的:探讨右旋美托咪啶(DEX)在严重创伤患者短期镇静治疗中对严重创伤后炎症因子的影响。方法:随机将60例入住重症监护病房(ICU)的严重创伤患者分为3组:DEX镇静组(DEX组,n=20)、咪达唑仑(MDZ)镇静组(MDZ组,n=20)和不用镇静剂的对照组(n=20)。DEX组:先静脉注射DEX负荷量1～2μg/kg(>10 min),继以微量注射泵持续静脉泵注维持量0.2～0.7μg.kg-1.h-1。MDZ组:先静脉注射MDZ负荷量0.03～0.3 mg/kg,继以微量注射泵持续静脉泵注维持量0.03～0.2 mg.kg-1.h-1。镇静2组均以Ramsay氏镇静评分分级Ⅱ～Ⅳ级为镇静目标,根据Ramsay评分调整用量,实施2 d的短程镇静治疗。分别检测患者在入院时、24h和48 h血清中白细胞介素1(IL-1)、IL-6、肿瘤坏死因子α(TNF-α)和C反应蛋白(CRP)水平。结果:3组患者TNF-α、IL-1、IL-6和CRP水平在入住ICU时均明显高于正常值,3组差异无统计学意义(P>0.05);对照组TNF-α、IL-1、IL-6和CRP在24 h和48 h逐步升高,而DEX组和MDZ组的上述指标有所下降,分别与对照组比较差异有统计学意义(P<0.05);DEX组和MDZ组TNF-α、IL-1、IL-6和CRP水平在24 h无显著差异(P>0.05),但在48 h差异显著(P<0.05)。结论:右旋美托咪啶可在一定程度上降低创伤后过度应激反应,阻止炎症介质的进一步产生和释放,有助于严重创伤患者的稳定和恢复。

AIM： To study the effect of short-term sedation by infusion of dexmedetomidine（DEX） on the inflammatory factors in the patients with severe trauma.METHODS： Sixty patients with severe trauma in ICU were randomly divided into 3 groups： DEX group（n=20）,midazolam（MDZ） group（n=20） and control group（without any sedatives,n=20）.Dexmedetomidine at an initial loading dose of 1～2 μg/kg was administered intravenously over 10 min to the patients in DEX group before the sedation procedure of continuous infusion at dose of 0.2～0.7 μg·kg-1·h-1 by a 50-mL infusion syringe was perform.Midazolam at dose of 0.03～0.3 mg/kg was also administered intravenously immediately before the procedure of a continuous infusion at dose of 0.03～0.2 mg·kg-1·h-1.The doses of DEX or MDZ for the patients receiving short-term（48 h） sedation were adjusted according to the Ramsay sedation scale scores.The serum levels of interleukins（IL-1 and IL-6）,tumor necrosis factor α（TNF-α） and C-reactive protein（CRP） were measured at the time points of the baseline（before the start of the study）,24 h and 48 h of sedative infusion.RESULTS： The levels of TNF-α,IL-1,IL-6 and CRP in the 3 groups of severe traumatic patients at the time when they were admitted to the hospital were significantly higher than those of the normal values.The levels of TNF-α,IL-1,IL-6 and CRP in control group gradually increased at 24 h and 48 h,while those in DEX group and MDZ group significantly declined.No significant difference of TNF-α,IL-1,IL-6 and CRP levels between DEX group and MDZ group was observed at 24 h,but the changes were significantly different at 48 h.CONCLUSION： Dexmedetomidine reduces over-stress responses to a certain extent in the traumatic patients to prevent the further production and release of inflammatory mediators,thus contributing to the stability and recovery of the patients with severe trauma.