不同剂量右美托咪定对全麻下纤维支气管镜检查时气道反应的影响

Effect of different dose of dexmedetomidine on airway response during fiberoptic bronchoscopy under general anesthesia

目的：研究不同剂量右美托咪定对全麻下纤维支气管镜检查时气道反应的影响。方法：选择本院择期拟在全身麻醉下行纤维支气管镜检查和治疗的老年患者60例进行研究,根据麻醉方法不同分为A组（丙泊酚复合舒芬太尼麻醉）、B组（0.25μg/kg右美托咪定联合丙泊酚、舒芬太尼麻醉）、C组（0.5μg/kg右美托咪定联合丙泊酚、舒芬太尼麻醉）、D组（0.75μg/kg右美托咪定联合丙泊酚、舒芬太尼麻醉）、E组（1.0μg/kg右美托咪定联合丙泊酚、舒芬太尼麻醉）。检查结束后检测血清中炎症反应指标、应激反应指标、抗氧化分子含量。结果：D、E两组血清中DAPK1、NLRP3、ASC、Caspase-1、IL-1β、IL-18、AD、NE、GRP78、JNK的含量均明显低于A、B、C组,D、E两组间DAPK1、NLRP3、ASC、Caspase-1、IL-1β、IL-18、AD、NE、GRP78、JNK的含量无差异;D、E两组血清中SOD、CAT、GSH-Px、MPO、Nrf2、ARE的含量均明显高于A、B、C组,D、E两组间SOD、CAT、GSH-Px、MPO、Nrf2、ARE的含量无差异。结论：不同剂量右美托咪定联合丙泊酚、舒芬太尼麻醉均能够抑制纤维支气管镜检查时气道反应所引起的炎症反应、氧化应激反应,0.75μg/kg和1.0μg/kg右美托咪定的效果相当。

Objective：To study the effects of different dose of dexmedetomidine on airway response during fiberoptic bronchoscopy under general anesthesia.Methods：A total of 60 elderly patients scheduled for electively receive fiberoptic bronchoscopy and treatment under general anesthesia in our hospital were selected for study and according to different ways of anesthesia,they were divided into group A（propofol combined with sufentanil anesthesia）,group B（0.25μg/kg dexmedetomidine combined with propofol and sufentanil anesthesia）,group C（0.5μg/kg dexmedetomidine combined with propofol and sufentanil anesthesia）,group D（0.75μg/kg dexmedetomidine combined with propofol and sufentanil anesthesia）and group E（1.0μg/kg dexmedetomidine combined with propofol and sufentanil anesthesia）.Then,the contents of serum inflammatory response indicators,stress response indicators and antioxidant molecules were detected.Results：Serum DAPK1,NLRP3,ASC,Caspase-1,IL-1β,IL-18,AD,NE,GRP78 and JNK contents of group D and E were significantly lower than those of group A,B and C,and but differences in DAPK1,NLRP3,ASC,Caspase-1,IL-1β,IL-18,AD,NE,GRP78 and JNK contents were not significant between group D and E;serum SOD,CAT,GSH-Px,MPO,Nrf2 and ARE contents of group D and E were significantly higher than those of group A,B and C,and SOD,CAT,GSH-Px,MPO,Nrf2 and ARE contents were not significant different between group D and E.Conclusion：Different dose of dexmedetomidine combined with propofol and sufentanil anesthesia can inhibit inflammatory response and oxidative stress response caused by airway response during fiberoptic bronchoscopy,and the effect of 0.75μg/kg-1and 1.0μg/kg dexmedetomidine was equivalent.