右美托咪定对脓毒症相关性脑病患者NGF、BDNF、GDNF、EPI表达的影响

Effects of dexmedetomidine on the expression of NGF,BDNF,GDNF and EPI in patients with sepsis associated encephalopathy

目的探索右美托咪定对脓毒症相关性脑病患者神经生长因子(NGF)、脑源性神经营养因子(BDNF)、胶质源性神经营养生长因子(GDNF)、肾上腺素(EPI)表达的影响。方法将脑功能障碍并躁动患者90例随机分为高剂量右美托咪定组[H组,1μg/(kg·h)]、低剂量右美托咪定组[L组,0. 4μg/(kg·h)]和对照组(C组,0. 9%氯化钠注射液)各30例。镇静组将患者镇静评分RASS评分滴定在-2～1分,分别在用药前(t0)、用药后48h(t1)、用药后96 h(t2)评估患者镇静评分,静脉采血并采用ELISA法测定血浆NGF、BDNF、GDNF、EPI水平。结果高剂量和低剂量右美托咪定组RASS评分均明显低于对照组(P均<0. 05),且H组的RASS评分更低(P <0. 05)。3组患者t2时点血浆NGF水平均明显下降(P均<0. 05),H组较另2组下降更明显(P均<0. 05); 3组各时点血浆BDNF水平比较差异无统计学意义(P均> 0. 05); H组血浆GDNF水平和EPI水平均显著下降(P均<0. 05),t2时与同时点另2组比较均下降显著(P均<0. 05)。结论右美托咪定可以降低脓毒相关性脑病患者血浆NGF、GDNF和EPI水平,通过降低血浆神经生长因子的水平减轻患者的躁动谵妄症状,从而保护脓毒症相关性脑病患者的脑功能。

Objective It is to explore the effect of dexmedetomidine on the expression of nerve growth factor (NGF), brain-derived neurotrophic growth factor (BDNF), glial-derived neurotrophic growth factor(GDNF), epinephrine (EPI) in patients with sepsis associated encephalopathy. Methods 90 patients with cerebral dysfunction and dysphoria were randomly divided into high dose dexmedetomidin group[group H, 1 μg/(kg·h)], low dose dexmedetomidin group [group L, 0.4 μg/(kg·h)] and control group (0.9% Nacl), each group had 30 cases. For sedation group, the RASS score of the patient was titrated at -2~1 score. The patient's sedation scores were evaluated before medication ( t 0), in 48 h ( t 1) and 96 h ( t 2) after medication.The concentration of plasma NGF, BDNF, GDNF and EPI was measured by ELISA method after venous blood collection. Results The RASS scores in group H and group L were significantly lower than that of the control group ( P <0.05), and the RASS scores of group H was the lowest ( P <0.05).The NGF plasma level at t 2 was significantly decreased in all groups( P <0.05),and the decrease in group H was more significant than that in the other two groups ( P <0.05). There was no significant difference in the level of plasma BDNF at each time point among the three groups ( P >0.05);the level of plasma GDNF and EPI in group H was decreased significantly ( P <0.05), compared with the other two groups at t 2, the decrease was more significantly in group H( P <0.05). Conclusion Dexmedetomidine can reduce the levels of plasma NGF, GDNF and EPI in patients with sepsis associated encephalopathy, reduce the level of plasma nerve growth factor and relieve the symptoms of agitation and delirium in order to protect the brain function of SAE.