右美托咪定靶控输注对胸腔镜下胸交感神经链切断术围术期机体炎性反应的影响

Effect of target-controlled dexmedetomidine infusion on the systemic inflammatory response in perioperative of thoracoscopic sympathectomy

目的探讨右美托咪定对胸腔镜下胸交感神经链切断术围术期机体炎性反应的影响。方法选取60例拟行胸腔镜下胸交感神经链切断术的手汗症患者,随机分为D组和N组,每组30例。D组麻醉诱导前给予右美托咪定1μg·kg^(-1),iv,然后以0.5μg·kg^(-1)·h^(-1)持续泵注至手术结束时停药。N组给予相同剂量0.9%氯化钠注射剂。记录麻醉前(T_0)、手术开始时(T_1)、手术结束时(T_2)和术后2 h(T_3)患者生命体征变化,测定不同时点机体细胞炎性因子IL-6和TNF-α的变化。结果与T_0相比,T_1时2组患者MAP、HR及N组患者IL-6和TNF-α均明显下降(P<0.05)。IL-6和TNF-α水平在T_2时,N组为(29.2±7.7)ng·L^(-1)和(2.4±0.3)ng·L^(-1),D组为(24.8±7.1)ng·L^(-1)和(1.7±0.2)ng·L^(-1),组间差异均有统计学意义(P<0.05);在T_3时,N组为(32.1±6.1)ng·L^(-1)和(2.8±0.3)ng·L^(-1),D组为(26.5±5.8)ng·L^(-1)和(1.8±0.2)ng·L^(-1),组间差异也均有统计学意义(P<0.05)。结论右美托咪定靶控输注可明显减轻胸腔镜下胸交感神经链切断术围术期机体炎性反应。

AIM To evaluate the effects of target-controlled dexmedetomidine infusion on the systemic inflammatory response in perioperative of thoracoscopic sympathectomy. METHODS A total of 60 patients who received thoracoscopic sympathectomy were randomly divided into 2 groups,30 patients in each group. Patients in group D received dexmedetomidine 1 μg·kg^-1 followed by dexmedetomidine 0. 5 μg ·kg^-1·h^-1 in 10 min preanesthesia before and group N were induced the same dose of 0. 9% sodium chloride injection. HR ,MAP and SpO2 were monitored and recorded before the anesthesia( T0 ),the time points of operation beginning( T1 ),at the end of operation ( T2 ) and 2 h after operation( T3 ),respectively. The serum cytokine ( IL-6 and TNF-α) concentration was determined at different times. RESULTS Compared with T0,MAP and HR in 2 groups and IL- 6 and TNF-α in group N were decreased significantly at T1 ( P < 0. 05). At T2,the levels of IL- 6 and TNF-α were ( 29. 2 + 7. 7) ng·L^-1 and ( 2. 4 + 0. 3) ng·L^-1 in group N and ( 24. 8 + 7. 1) ng·L^-1 and ( 1. 7 + 0. 2) ng· L^-1 in group D. There were significant differences between 2 groups ( P < 0. 05). At T3,the levels of IL-6 and TNF-α were ( 32. 1 + 6. 1) ng·L^-1 and ( 2. 8 + 0. 3) ng·L^-1 in group N,and ( 26. 5 + 5. 8) ng·L^-1 and ( 1. 8 + 0. 2) ng·L^-1 in group D. The differences between 2 groups were also significant ( P < 0. 05). CONCLUSION Target-controlled dexmedetomidine infusion can effectively alleviate the systemic inflammatory response in perioperative of thoracoscopic sympathectomy.