右美托咪啶对老年患者全麻术后炎症因子水平及单核细胞TLR2和TLR4表达的影响

Effects of dexmedetomidine on inflammatory response and monocytes Toll- like receptor 2 and Toll- like receptor 4 expression in elderly patients receivmg abdominal operation in general anesthesia

目的观察右美托咪啶对老年腹部手术患者围术期炎症因子水平及单核细胞TLR2和TLR4表达的影响。方法选择老年全麻患者91例,采用随机数字表法将患者分为:右美托咪啶组(D组)46例和对照组(C组)45例。两组均常规咪达唑仑、顺苯磺酸阿曲库铵、舒芬太尼、依托咪酯行麻醉诱导,诱导前10min,D组静脉输注右美托咪啶针,负荷量0.5μg/kg,再分别恒速静脉输注右美托咪啶针0.5μg/(kg·h)至术毕前30min;C组采用同样方法静脉输注等容量0.9%氯化钠溶液。记录舒芬太尼、瑞芬太尼和异丙酚用量。于麻醉前(T_0)、手术开始1h(T_1)、手术结束后12h(T_2)及24h(T_3)时各采集右颈内静脉血5ml,采用ELISA测定HMGBl、TNF-α、IL-6水平,并采用流式细胞仪检测单核细胞TLR2和TLR4的表达水平。结果与C组比较,D组瑞芬太尼针和丙泊酚针用量明显减少(P<0.01),舒芬太尼用量差异无统计学意义(P>0.05)。与C组比较,D组TNF-α、IL-6和HMGB1水平在T_1、T_2、T_33个时点均明显降低(P<0.05);D组单核细胞TLR2和TLR4的表达水平在T_1、T_2、T_33个时点均明显降低(均P<0.05)。结论右美托咪啶可以降低老年腹部手术患者围术期炎症因子水平及抑制单核细胞TLR2和TLR4表达。

Objective To investigate the effects of dexmedetomidine on inflammatory response and monocytes Tol- like receptor 2 and Tol- like receptor 4 expression in elderly patients receiving abdominal surgery in general anesthesia. Methods Ninty one ASA physical status I orⅡpatients,aged 63- 80 yr ,scheduled for elective abdominal surgery under general anesthesia were randomly divided into two groups：control group （group C, n=45） and dexmedetomidine group （group D, n=46）. Anesthesia was induced with midazolam, cisatracurium besilate, fentanil and etomidate. In group D, dexmedetomidine was infused over 10 min with loading dose 0.5μg/kg and then0.5μg/ （kg＆#183;h） as a maintenance dose until 30 min before the end of operation. Group C patients received the same volume of saline. Total anesthetics consumption were recorded. Before anesthesia induction（T0）, at 1 h after the beginning of operation（T1）, at 12 h after operation（T2） and at 24 h after operation（T3）, venous blood samples were taken for determination of monocytes Tol- like receptor 2 and Toll- like receptor 4 expression by flow cytometrybased method and for serum concentrations of TNF- α、IL- 6 and high mobility group box- l protein （HMGBl） by ELISA. Results The consumption of anesthetics were lower in dexmedetomidine group than that in control group （P〈0.05）. Compared with group C, the expression of TLR2 and TLR4 in monocytes of venous blood was significantly down- regulated in dexmedetomidine group at the point of T1, T2 and T3 （P〈0.05）, and the serum TNF- α、IL- 6 and HMGBl levels were decreased in dexmedetomidine group at the point of T1, T2 and T3 （P〈0.05）. Conclusion Dexmedetomidine can suppress the inflammatory cytokines released and down regulate the expression of TLR2 and TLR4 in monocytes of venous blood.