右美托咪定用于脊柱手术控制性降压时对炎症因子的影响

Effect of deliberate hypotension of dexmedetomidine on inflammatory factors in patients undergoing surgery for spinal

目的观察右美托咪定对脊柱手术控制性降压患者术后炎性因子水平的影响。方法 60例择期在全麻下拟行胸腰椎骨折减压内固定术的患者,随机分为对照组(Sham组,n=30)和右美托咪定组(Dex组,n=30).抽取麻醉诱导前30 min(T1)、气管导管拔出即刻(T2)、术毕2 h(T3)、术毕6 h(T4)、术毕12 h(T5)、术毕24 h(T6)的外周静脉血,测定C反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。结果两组患者的一般情况及术中各监测指标比较,差异无统计学意义(P>0.05);与Sham组比较,Dex组CRP、IL-6和TNF-α在T2-6各时点均降低,差异有统计学意义(P<0.05);与T1比较,Sham组中,CRP从T3时点开始升高,IL-6、TNF-α均从T2时点开始升高,在T4时点升至最高点,T5时点开始下降;Dex组,CRP从T4时点开始升高,IL-6、TNF-α均从T3时点开始升高,在T4时点升至最高点,T5时点开始下降,差异有统计学意义(P<0.05)。结论右美托咪定用于脊柱手术控制性降压安全可行,并且可以降低炎症反应,提高安全性。

Objective To investigate the effects of deliberate hypotension of dexmedetomidine on inflammatory factors in patients undergoing surgery for spinal. Methods A total of 60 patients who underwent decompression of thoracolum- bar fracture fixation under general anesthesia were randomly divided into 2 groups,sham group （Sham group） and dexmedetomidine group （Dex group）, 30 in each group. The cervical venous blood samples were obtained from the pa- tient at 30 rain before anesthesia induction （T1）, when endotracheal tubewas removed （T2） and 2 h（T3）,6 h（T4）,12 h（Ts）, 24 h （T6） postoperation for determination of the expression of CPR,IL-6 and TNF-α Results The difference of the general situation and the monitoring indicators of intraoperative between the patients of the two groups was not statisti- cally significant（P〉0.05）; compared with sham group, CPR, IL-6 and TNF-α of Dex group were all lower at each time point of T2-T6, difference was statistically significant （P〈0.05）; compared with T1,CPR of sham group was bagan to rise from T3, IL-6 and TNF-α of sham group were bagan to rise from T2, and rosen to the highest at T4, bagan to de- cline at T5; CPR of Dex group was bagan to rise from T4, IL-6 and TNF-α of Dex group were bagan to rise from T3, and rosen to the highest at T4, bagan to decline at T5, difference was statistically significant （P〈0.05）. Conclusion De- liberate hypotension of dexmedetomidine in patients undergoing surgery for spinal is safe and feasible,and can reduce inflammation,improve security.