右美托咪定对围术期脓毒症患者肠屏障功能保护作用的研究

Effects of dexmedetomidine on perioperative intestinal barrier function in patients with sepsis

目的比较120例围术期脓毒症患者术后5项指标变化情况及术后28天死亡率,评价右美托咪定对脓毒症患者肠屏障功能的保护作用。方法选择2014年3月—2015年9月在宁波市第一医院行外科手术脓毒症患者120例,按照随机数字表法将120例患者分为观察组60例,对照组60例。观察组麻醉前10分钟泵注右美托咪定(0.6μg/kg),麻醉诱导后泵注右美托咪定[0.5μg/(kg·h)]直至术毕前30 min,对照组泵注生理盐水。比较两组基线值,术后7 d肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血浆肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(TAO)和D-乳酸(D-Lac)指标变化情况及术后28天死亡率。结果两组患者治疗后TNF-α、IL-6、IFABP、TAO、D-Lac 5项指标均显著低于治疗前,差异具有统计学意义(P<0.05)。观察组治疗后各项指标均显著低于对照组,差异具有统计学意义(P<0.05)。观察组和对照组28天内死亡率分别为11.67%和30.00%,差异具有统计学意义(P<0.05)。结论治疗后观察组TNF-α、IL-6、IFABP、TAO、D-Lac 5项指标下降较对照组明显,28天内死亡率较对照组低,脓毒症患者围术期给予右美托咪定对术后肠屏障功能和预后有一定保护和改善作用。

Objective To evaluate the protective effect of dexmedetomidine on perioperative intestinal barrier function in 120 patients with sepsis through comparing the 5 indicators after the operation and 28 day mortality rate. Methods A to- tal of 120 cases of sepsis undergoing surgical treatment in our hospital between March,2014 and September,2015 were enrolled and randomly divided into observation group and control group with 60 cases in each group. In the observation group, dexmedetomidine continuous infusion via an infusion pump was performed 10 minutes before anesthesia（0.6 μg/ kg） and after induction of anesthesia[0.5 μg/（ kg · h）] until 30 minutes before the end of the surgery;In the control group, normal saline was used instead of dexmedetomidine. The baseline values and postoperative levels （7 days after surgery） of Tumor Necrosis Factor-α （TNF-α）, Interleukin 6 （IL-6）, Plasma levels of Intestinal Fatty Acid Binding Protein （IFABP） Two Amine Oxidase（TAO） and D-Lactic acid（D-Lac） were compared between the two groups. The 28 day mortality rate was also compared between the two groups. Results in the two groups were significantly lower than those before treatment, the difference was statistically significant （ P 〈 0.05 ）. The observation group after treatment, the indicators were significantly lower than the control group, the difference was statistically significant （P 〈 0.05 ）. The mortality rate of observation group and control group was 11.67% and 30.00% within 28 days, the difference was statistically sig- nificant （P 〈 0.05）. Conclusion The levels of TNF-α, IL-6, IFABP, TAO and D-Lac in the observation group were sig- nificantly lower than those in the control group at 28 days after the treatment. In the septic group, The postoperative intesti- nal barrier function and prognosis of a certain protection and improvement.