咪达唑仑和右美托咪定对危重脓毒症患者的炎性反应和胃黏膜pH值的影响

Effects of dexmedetomidine and midazolam on inflammatory response and gastric intramucosal pH in critically ill patients with sepsis

目的 对比咪达唑仑和右美托咪啶对炎性反应相关指标和胃黏膜pH值的影响.方法 将40例脓毒症患者随机分为咪达唑仑组（n =20,M组）和右美托咪定组（n=20,D组）,用ELASE法检测TNF-α,IL-1β和IL-6水平,使用标准的pH值和血气分析仪同时分析和计算胃黏膜pH值.结果 D组与M组间血流动力学、生化指标和胃黏膜pH值差异无统计学意义,而24 h后D组较M组心率[（86±3.37）和（110 ±3.29） bpm],TNF-α[（19.3±5.6）和（14.5 ±4.1）pg/mL],IL-1β[（6.29±2）和（5±0.32） pg/mL],IL-6[（457.4±337.2）和（215.6±194.3） pg/mL]均有显著性降低（P＜0.05）.结论 右美托咪定用于脓毒症患者的镇静可有效减轻炎性反应.

ObjeetiYe To study the effect of midazolam and dexmedetomidine on the inflammato- ry-response related indicators and gastric intramucosal pH in critically ill patients with sepsis. Methods Fonrty patients with sepsis were allocated into the dexmedetomidine group （ n = 20, Group D） and midazo- lam group （n = 20, Group M）. Arterial blood was taken and analysed with standard pH and blood-gas anal- ysers. Tumor necrosis factor-α （ TNF-α ）, interleukin-1β （ IL-1β ）, and interleukin-6 （ IL-6 ） levels were measured with ELASE method. Results There were no statistically significant differences in haemody- namic and biochemical measurements and gastric intramucosal pH between the groups. Compared with Group M,the levels of Group D in heart rate（ 110 ± 3.29 vs 86 ± 3.37 bpm） ,TNF-α（ 19.3 ± 5.6 vs 14.5 _±4.1 pg/mL） ,IL-113（6.29 ±2 vs5_±0.32 pg/mL） and IL-6（457.4 ±337.2 vs 215.6 _±194.3 pg/ mL） were significant decreased after 24 hours （ P 〈 0.05 ）. Conclusion Dexmedetomidine may alleviate inflammatory effects in sepsis patients during sedation.