盐酸右美托咪定对非体外循环冠状动脉搭桥术患者的肺保护作用

Protective effect of dexmedetomidine on lung injury in patients undergoing off-pump coronary artery bypass grafting

①目的探讨盐酸右美托咪定(以下称右美托咪定)对非体外循环冠状动脉搭桥术(OPCABG)患者的肺保护作用。②方法随机选择OPCABG的冠心病患者30例,采用随机数字表法,分为右美托咪定组12例,对照组18例。右美托咪定组患者入室后在麻醉诱导前10分钟输注右美托咪定1.0μg/kg,然后以0.5μg/(kg·h)的速率维持到术毕。对照组输注等量生理盐水。分别在入室后(T0)、术毕(T1)、术毕24小时(T2)、术毕48小时(T3)采集外周静脉血3mL,应用ELISA法测定白细胞介素-10(IL-10),肿瘤坏死因子-α(TNF-α),Clara细胞分泌蛋白(CC16)的含量。③结果对照组TNF-α及CC16在T1、T2、T3高于T0(P<0.05),血清IL-10水平在T2、T3时均高于T0(P<0.05)。右美托咪定组TNF-α,IL-10在T1、T2、T3时与对照组比较差异具有统计学意义(P<0.05),CC16在T2时间点显著低于对照组。右美托咪定组TNF-α在T2时高于T0,IL-10水平在T2、T3时水平均高于T0,CC16在T1、T2、T3与T0比较均明显升高,差异具有统计学意义(P<0.05)。④结论右美托咪定用于OPCABG患者可抑制麻醉手术期间机体炎症反应,对麻醉手术期间的肺脏有一定的保护作用。

Objective To study protective effect of dexmedetomidine on lung injury in patients undergoing off-pump coronary artery bypass grafting （OPCABG）.Methods Randomly selection thirty patients undergoing OPCABG,using the random number table method was divided into two groups：the dexmedetomidine group （group D,n=12）and the control group（group C,n=18）.Group D re-ceived iv dexmedetomidine 1.0μg/kg within 10min before anesthesia induction and continuous infusion 0.5μg/（kg·h）in the surgery.Group D received iv the equal volume of saline.Blood samples were taken through peripheral vein at the following time points：before induction of anesthesia（T0 ）,immediately end of surgery（T1）,24h post-surgery（T2）,48h post-surgery（T3）.Serum TNF-α,IL-10 and CC16 con-centrations were assayed by ELISA.Results Compared with T0 ,Group C in TNF-αand CC1 6 at point of T1-T3 were significantly increased and in IL-10 at T2-T3 were increased compared with T0（P 〈0.05）.There were significant differences in TNF-αand IL-10 between the two groups at point of T1-T3（P 〈0.05）.Compared with group C,group D in CC16 was significantly decreased at T2.Compared with T0 ,Group D in TNF-αat T2 ,IL-10 at T2-T3 and CC16 at T1-T3 were significantly increased（P〈0.05）.Conclusion Dexmedetomidine applicated in patients undergoing OPCABG can inhibit the re-action of inflammation during anesthesia and operation,and has certain protective effect to the lungs.