右美托咪定对体外循环下全身炎症反应综合征的保护效果观察

Protective Effects of Dexmedetomidine on Systemic Inflammatory Response Syndrome during Cardiopulmonary Bypass

目的:观察右美托咪定(DEX)对体外循环(CPB)下患者全身炎症反应综合征(SIRS)的保护效果。方法:择期体外循环下行心脏二尖瓣置换术的患者62例,随机分为DEX组和对照组各31例。DEX组恒速输注DEX 0.5μg·kg^(-1)·h^(-1),对照组恒速输注等量0.9%氯化钠注射液。其余麻醉用药两组相同。分别于麻醉诱导前(T0)、主动脉开放后10 min(T1)、停机时(T2)、停机后4 h(T3)、停机后12 h(T4)和停机后24 h(T5)监测两组患者血清炎性细胞因子C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8、IL-10的水平以及患者生命体征,比较两组患者术后机械通气时间、ICU观察时间、术后24h发生SIRS例数及住院天数。结果:T1~T5时两组患者血清CRP明显升高(P<0.05);T3~T5时DEX组CRP明显低于对照组(P<0.05)。T2~T4时对照组血清TNF-α明显升高(P<0.05),T2、T3时DEX组血清TNF-α明显升高(P<0.05);T3、T4时DEX组血清TNF-α低于对照组(P<0.05)。T2~T5时两组血清IL-6明显升高(P<0.05),T1~T5时两组血清IL-8明显升高(P<0.05),T1~T3时两组血清IL-10明显升高(P<0.05);T2~T4时DEX组IL-6、IL-8低于对照组(P<0.05),T1~T3时DEX组IL-10高于对照组(P<0.05)。T3~T5时两组患者WBC均较T0时显著升高(P<0.05),且对照组WBC高于同期DEX组(P<0.05)。两组患者术后机械通气时间、ICU观察时间、术后24 h内诊断SIRS例数、住院天数、药品不良反应发生例数等比较,差异无统计学意义(P>0.05)。结论:CPB期间持续输注右美托咪定能降低患者血清炎性细胞因子水平,一定程度减轻全身炎症反应。

Objective： To investigate the effects of dexmedetomidine （DEX） on oxidative stress and systemic inflammatory re- sponse syndrome （SIRS） during cardiopulmonary bypass （CPB）. Methods： Totally 62 patients scheduled for mitral valve replacement surgery were enrolled in this study and randomly assigned to DEX group with constant infusion of DEX （0.5μg kg -1 h-1, n = 31 ） and the control group with the same amount of 0.9% sodium chloride injection（ n = 31 ）. A volume of 4 ml of jugular vein blood was respectively withdrawn before the ＂induction of anesthesia （T0）, at 10 rain after aortic-off clamping（ T1 ）, the end of bypass（ T2）, 4h after bypass （ T3 ）, 12h after bypass （ T4 ） and 24h after bypass （ T5 ）. The serum C-reactive protein （ CRP）, tumor necrosis factor-α （ TNF-α）, interleukin-6 （ IL-6）, interleukin-8 （ IL-8 ） and interleukin-10 （IL-10） were determined. Results： The serum CRP in both groups increased remarkably at T1-T5 , while the serum CRP in DEX group was significantly lower than those in the control group at T3-TS. The serum TNF-α increased remarkably in control group at T2-T4, while the serum TNF-α increased remarkably in DEX group at T2-T3 ;the serum TNF-α in DEX group was significantly lower than those in the control group at T3-T4. The serum IL-6, IL-8, IL- 10 in both groups were increased remarkably at T2-TS, T1-T5 ,T1-T3, respectively. The serum IL-6 and IL-8 in the DEX group were significantly lower than those in the control group at T2-T4 while the serum IL-10 in the DEX group was significantly higher than that in the control group at T1-T3. The serum WBC in both groups at T3-T5 were higher than those at TO, while the serum WBC in the control group was significantly higher than that in the DEX group at T3-T5. However, the differences between the two groups at mechanical ventilation time, ICU observation time, the incidence of postoperative SIRS after 24h, hospitalization days, and the adverse reactions were not statistically significant. Conclusion： DEX has notable protective effects on systemic inflammatory response syndrome during extracorporeal circulation.