右美托咪啶对婴幼儿体外循环心脏手术全身炎性反应的影响

The Anti-inflammatory Effect of Dexmedetomidine in Pediatric Open Heart Surgery under Cardiopulmonary Bypass

目的观察右美托咪啶对婴幼儿体外循环心脏手术围术期全身炎性反应的影响。方法选择行体外循环心脏矫治手术的1-3岁小儿常见简单先天性病患者80例,随机分为右美托咪啶组和对照组各40例。右美托咪啶组在麻醉诱导插管并建立中心静脉后静脉泵入负荷量右美托咪啶4ug/kg*h持续15分钟,之后维持剂量调节为0.5ug/kg*h至手术结束,对照组同时间静脉泵入等容量生理盐水。分别于体外循环前(T0)、结束(T1)、术后6h(T2)、术后24小时(T3)抽取中心静脉血,测定血清中肿瘤坏死因子(TNF-α)和白细胞介素6(IL-6)、白细胞介素10(IL-10)的含量。结果两组体外循环前TNF-α、IL-6、IL-10无统计学意义(P>0.05),体外循环后两组TNF-α、IL-6、IL-10较体外循环前均明显增高,至T2达最高峰(P<0.01);与对照组相比,右美托咪啶组T1、T2、T3时间点TNF-α和IL-6均降低(P<0.01),而IL-10升高(P<0.01)。结论右美托咪啶可减轻婴幼儿体外循环心脏手术期间全身炎性反应程度,降低血浆中促炎因子TNF-α和IL-6浓度、增加抑炎因子IL-10浓度。

Objective To observe the anti-inflammatory effect of dexmedetomidine in pediatric open heart surgery under cardiopulmonary bypass. Methods 100 pediatric patients suffered open heart surgery were randomly divided into 2 groups, the dexmedetomidine （n=50） and the control group （n=50）. The drugs were given by two stages, first injection at 4ug/kg＊h for 15 min, and then maintained at 0.5ug/kg＊h until the operation finished. TNF-α, IL-6 and IL-10 were determined with the central venous blood that extracted before the cardiopulmonary bypass （T0）,at the time of cardiopulmonary bypass finished （T1）, and 6, 24h at postoperative （T2 ,T3）. Results The difference of TNF-α, IL-6, IL-10 were not statistically significant （P 〉 0.05） before the cardiopulmonary bypass. TNF-α、 IL-6 and IL-10 were significantly increased after cardiopulmonary bypass and further increased at T2 time in both the two groups ; Compared with the control group, the TNF-α and IL-6 were decreased at the T1, T2 and T3 time while the IL-10 were increased in dexmedetomidine group. Conclusion Dexmedetomidine has obivious anti-inflammatory effect in the pediatric open heart surgery under cardiopulmonary bypass. It can decrease the release of TNF-α and IL-6 and increase the secretion of IL-10.