右美托咪啶对急诊冠状动脉旁路移植术中白细胞介素-22表达的影响

Effect of dexmedetomidine on interleukin - 22 in acute cornary artery bypass

目的观察右美托咪啶对急诊冠状动脉旁路移植术中白细胞介素-22（IL-22）表达的影响。 方法60例急诊冠状动脉旁路移植术患者随机分为右美托咪啶组和对照组，以静脉注射咪达唑仑、依托咪酯、舒芬太尼、阿曲库铵麻醉诱导，以静脉泵入丙泊酚、瑞芬太尼麻醉维持，间断静脉注射阿曲库铵，间断吸入七氟醚。右美托咪啶组于麻醉诱导前静脉泵入右美托咪啶1.0 μg/（kg·h）10 min后，持续静脉泵入右美托咪啶0.5 μg/（kg·h）维持，对照组同期给以等量生理盐水。于T1（麻醉诱导后）、T2（吻合血管前）、T3（术后6 h）、T4（术后3 d）、T5（术后7 d）5个时间点采空腹静脉血4 ml，采用酶联免疫吸附法检测IL-22及白细胞介素-6（IL-6）水平。结果右美托咪啶组IL-22及IL-6水平在T2、T3、T4、T5均显著低于对照组：IL-22（T2：10.03±1.10比13.65±1.21，P＝0.001；T3：13.31±1.01比18.23±1.32，P＝0.001；T4：25.35±1.28比38.56±1.03，P＝0.001；T5：20.47±1.28比35.39±1.03，P＝0.001），IL-6（T2：201.85±26.54比237.65±35.45，P＝0.001；T3：241.65±30.12比284.62±36.25，P＝0.001；T4：117.62±13.62比136.21±12.36，P＝0.001；T5：97.62±10.10比116.21±11.12，P＝0.001）。结论 右美托咪啶在急诊冠状动脉旁路移植术中能够降低IL-22及IL-6水平，发挥抗炎及免疫调节作用。

To investigate the effect of dexmedetomidine on interleukin-22 （IL-22） in acute cornary artery bypass.Methods The patients undergoing acute coronary artery bypass graft surgery were selected, and randomly divided into dexmedetomidine group and control group （n=30 in each group）. The anesthesia in in both two groups was induced with midazolam, etomidate, sufentanil and Atracurium, maintained with propofol and remifentanil, and given intermittent Atracurium （injection） and intermittent sevoflurane （inhalation）. In the dexmedetomidine group, 1.0 μg/（kg·h） dexmedetomidine was intravenously pumped 10 min before induction of anesthesia, and the anesthesia was maintained by continuously intravenous injection of 0.5 μg/（kg·h） dexmedetomidine. The same volume of normal saline was given at the same period. At T1 （after induction of anesthesia）, T2 （before vascular anastomosis）, T3 （6 h after operation）, T4 （3 days after operation）, T5 （7 days after operation）, 4 mL venous blood was obtained for determination of IL-22 and IL-6 by enzyme-linked immunosorbent assay.Results IL-22 and IL-6 levels were significantly higher in the dexmedetomidine group than in the control group at T2, T3, T4 and T5 [for IL-22 （T2： 10.03±1.10 vs. 13.65±1.21, P=0.001; T3： 13.31±1.01 vs. 18.23±1.32, P=0.001; T4： 25.35±1.28 vs. 38.56±1.03, P=0.001; T5： 20.47±1.28 vs. 35.39±1.03, P=0.001）; for IL-6 （T2： 201.85±26.54 vs. 237.65±35.45, P=0.001; T3： 241.65±30.12 vs. 284.62±36.25, P=0.001; T4： 117.62±13.62 vs. 136.21±12.36, P=0.001; T5： 97.62±10.10 vs. 116.21±11.12, P=0.001）.Conclusion The application of dexmedetomidine can decrease IL-22 and IL-6 levels in acute cornary artery bypass, and exert its anti-inflammation and immune regulation effects.