右美托咪啶对微创冠脉旁路移植患者术中肺部核因子-κB通路的影响

Effect of dexmedetomidine on pulmonary nuclear factor -κB pathway in patients undergoing mini-maUy invasive coronary artery bypass grafting

目的观察右美托咪啶对微创冠脉旁路移植患者术中肺部炎症核因子-κB（NF-κB）信号通路的影响。方法22例接受微创冠状动脉旁路移植术患者随机均分为右美托咪啶组和对照组，两组患者均静脉全身麻醉诱导，以静脉泵人丙泊酚、舒芬太尼麻醉维持，间断静脉注射顺阿曲库铵。右美托嘧啶组于麻醉诱导前静脉泵入右美托咪啶1．0μg／（kg．h）10min后，持续静脉泵入右美托咪啶0．5μg／（kg·h）维持，对照组同期给以等量生理盐水，于T1（气管插管后）、T2（单肺通气30min、吻合血管前）、T3（双肺通气即刻）、T4（术后6h）、T5（术后3d）5个时间点采集颈内静脉血4ml，于T1-T3时间点采集通气侧肺泡灌洗液采用酶联免疫吸附法测定血浆及肺泡灌洗液高迁移率族蛋白B1（HMGBl）、NF-κ浓度。结果右美托嘧啶组血浆HMGBl、NF-κB水平在T3、T4、T5点低于对照组：HMGB1（1．81±0．09比2．45±0．13，P=0．010；2．25±0．16比3．52±0．21，P=0．001：2．17±0．20比3．48±0．23，P=0．001），NF-κB：（40．05±1．85比84．62±3．25，P=0．001；45．52±1．21比96．21±2．36，P=0．010；43．48±1．23比88．53±2．12，P=0．001）；右美托嘧啶组肺泡灌洗液HMGBl、NF-κB水平在他、B低于对照组：HMGB1（3．78±0．67比5．14±0．85，P=0．001；4．83±0．64比8．25±1．13，P=0．001）；NF-κB：（50．02±2．13比66．60±2．27，P=0．001；62．01±2．85比86．61±3．15，P=0．001）。结论右美托嘧啶对微创冠脉旁路移植术中，通过降低HMGB1、NF-κB水平，抑制NF-κB炎症通路，发挥抗炎作用。

Objective To observe the effect of dexmedetomidine on pulmonary nuclear factor -κB （NF -κB） signaling pathway in patients undergoing minimally invasive coronary artery bypass grafting. Methods Twenty - two patients undergoing minimally invasive coronary artery bypass grafting were randomly divided into dexmedetomidine group and control group. The intravenous general anesthesia was induced in both groups and maintained by intravenous infusion of propofol and snfentanil, and intermittent intravenous injection of cisatracurium was done. In dexmedetomidine group, dexmedetomidine was intravenously pumped at 1.0 μg/（kg-h） for 10 min before anesthesia induction, and then continuously intravenously pumped at 0. 5 μg/（kg.h） for maintenance. The control group received the same amount of normal saline at the same time. 4 ml of jugular vein blood was collected at T1 （after tracheal intubation）, T2 （before one lung ventilation, 30 min of anastomosis）, T3 （immediate after double lung ventilation）, T4 （6 h after operation） and T5 （3 days after operation）. The concentrations of HMGB1 and NF - κB in plasma and alveolar lavage fluid were determined by enzyme - linked immunosorbent assay （ELISA） at T1 - T3 time points. Results The plasma levels of HMGB1 and NF - κB in the dexmedetomidine group were lower than those in the control group at T3, T4 and T5 （for HMGB1 ： 1.81 ± 0. 09 vs. 2. 45 ±0.13 ,P = 0. 010; 2.25±0.16 vs. 3.52±0.21,P=0.001; 2.17 ±0.20 vs. 3.48 ±0.23,P=0.001. for NF- κB： 40.05±1.85 vs. 84.62±3.25,P=0.001; 45.52±1.21 vs. 96.21±2.36,P=0.010; 43.48 ±1.23 vs. 88.53 ±2. 12,P =0. 001）. The levels of HMGB1 and NF - κB in the lung lavage fluid of dexmedeto- midine group were lower than those in the control group （ for HMGB1 at T2 and T3 ： 3.78 ±0.67 vs.5.14 ±. 85 ,P =0. 001 ; 4. 83 ±0. 64 vs. 8.25 ±1.13 ,P =0. 001. For NF - κB： 50. 02 ± 2. 13 vs. 66. 60 ±2. 27,P =0.001 ; 62. 01 ±2. 85 vs. 86. 61 ±3.15,P = 0. 1301 ）. Conclusion Dexmedetomidine may exert its anti - inflammatory effects by decreasing HMGB1 and NF - κB levels and inhibiting NF - κB signaling pathway in patients undergoing minimally invasive coronary artery bypass grafting.