右美托咪啶对瓣膜置换术患者血中炎症介质的影响

Effect of dexmedetomidine on serum inflammatory mediator in cardiac valve replacement surgery

目的评价右美托咪啶(Dexmedetomidine)对体外循环(CPB)瓣膜置换术时患者血中炎症介质的影响。方法选择30例择期在CPB下行瓣膜置换术的患者作为观察对象,随机分为实验组和对照组,每组15例。实验组于麻醉诱导完成后以0.2μg.kg-1.h-1的速度静脉泵注右美托咪啶,对照组泵注等容积的生理盐水。分别于麻醉诱导后切皮前(T1)、CPB开始时(T2)、CPB开始后40min(T3)、停机2h(T4)、CPB结束后24h(T5)5个时间点采集桡动脉血,酶联免疫吸附(ELISA)法检测血清标志物肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)的水平。结果组间比较,在T1～T2时两组血清标志物比较差异无统计学意义(P>0.05),T3～T5时实验组TNF-α、IL-6均明显低于对照组(P<0.05或P<0.01),而IL-10明显高于对照组(P<0.01);组内对比,各组血清标志物在T3～T4时均明显增高(P<0.01),IL-6、IL-10在T5恢复至手术开始水平,TNF-α仍保持较高水平(P<0.05或P<0.01)。结论术中泵入右美托咪啶可有效地调节CPB瓣膜置换术时炎症介质的释放,从而抑制由此引起的炎症反应的程度。

Objective To evaluate the effect of dexmedetomidine on inflammatory response and the changes of serum inflammatory mediator caused by cardiopulmonary bypass（CPB）in cardiac valve replacement surgery.Methods 30 patients scheduled for cardiac valve replacement were randomly divided into two groups：experimental group（n=15）and control group（n=15）.For the experimental group,dexmedetomidine was infused intravenously with the dose of 2.0μg.kg-1.h-1 after induction of anesthesia.In control group,normal saline was given instead of dexmedetomidine.Blood samples were taken from radial artery in each of the following five time points：after induction of anesthesia（T1）,the beginning of CPB（T2）,after beginning of CPB 40min（T3）,after the termination of CPB 2h（T4）and 24h（T5）for determination of TNF-α、IL-6、IL-10.Results The concentration of TNF-α、IL-6、 IL-10levels showed no significantly difference between the two groups before CPB（P0.05）.But serum TNF-α、IL-6levels of experimental group were significantly lower and IL-10 were significantly higher than control group（P0.05or P0.01）at the time points of T3～T5.All biomakers rose significantly at the time of T3 and T4 in both groups（P0.05or P0.01）.At the time of T5 IL-6、IL-10returned to preoperative levels（P0.05）while TNF-αremained heigh level（P0.05or P0.01）in both groups.Conclusion dexmedetomidine can regulate the release of the serum inflammatory mediator which suggest that dexmedetomidine may alleviate the systemic inflammatory reaction resulting from cardiopulmonary bypass in cardiac valve replacement surgery.