丙泊酚与右美托咪定干预肠梗阻术后脓毒症患者炎症应答反应的对比研究

Comparative study of propofol and dexmedetomidine on inflammatory responses in patients with sepsis

目的比较丙泊酚与右美托咪定干预肠梗阻术后脓毒症患者的炎症应答反应情况。方法将40例肠梗阻术后行机械通气的脓毒症患者分为右美托咪定组及丙泊酚组,每组均为20例。丙泊酚组予以静脉输注丙泊酚,15 min内给予初始负荷剂量1 mg/kg,后予以3 mg·kg-1·h-1微泵持续静脉维持行镇静治疗。右美托咪定组初始于10 min给予以负荷剂量1.0μg/kg,后予以0.2-2.5μg·kg-1·h-1微泵持续静脉维持行镇静治疗。两组患者镇静时间均大于24 h。分别于镇静治疗前、镇静后24 h及48 h记录患者的肿瘤坏死因子α（TNF-α）,白细胞介素1（IL-1）、IL-6。结果右美托咪定组中的TNF-α、IL-1及IL-6在镇静后24 h均显著低于丙泊酚组（t=2.113、2.567、2.823,P均〈0.05）,且在镇静后48h右美托咪定组血浆中TNF-α、IL-1及IL-6均显著低于丙泊酚组（t=3.474、2.248、2.382,P均〈0.05）。结论与丙泊酚相比,静脉持续输注右美托咪定可以降低脓毒症患者血浆中TNF-α、IL-1和IL-6水平。

Objective To compare the effects of propofol and dexmedetomidine on inflammatory responses in patients with sepsis after intestinal obstruction surgery. Methods Total of 40 mechanical ventilation patients with sepsis after intestinal obstruction surgery were divided into the dexmedetomidine group and propofol group, 20 cases in each group. Patients in the propofol group received a loading dose infusion of propofol 1 mg/kg within 15 minutes, then followed by a maintenance dose of 3 mg·kg^-1·h^-1. Meanwhile, the patients in the dexmedetomidine group received a loading dose of dexmedetomidine 1.0 μg/kg within 10 minutes, then followed by a maintenance dose of 0.2 - 2.5 μg·kg^-1·h^-1 over 24 hours. The levels of tumor necrosis factoralpha （TNF-α, interleukin-1 （IL-1） and IL-6 before and 24 h, 48 h after sedation were recorded and compared in the two group. Results The levels of TNF-α, IL-1 and IL-6 in the dexmedetomidine group at 24th hour were much lower than those in the propofol group （t = 2.113, 2.567, 2.823, all P〈0.05）. And the above indicators in the dexmedetomidine group at 48th hour were also lower than those in the propofol group （t = 3.474, 2.248, 2.382, all P 〈 0.05）. Conclusion Compared with propofol, dexmedetomidine infusion can decrease TNF-α, IL-1 and IL-6 levels significantly.