不同剂量右美托咪定用于全麻烧伤切痂植皮手术对患者应激指标及炎性因子的影响

Effects of Different Doses of Dexmedetomidine on Stress Indicators and Inflammatory Factors in Burn Patients undergoing Escharectomy and Skin Grafting under General Anesthesia

目的:探讨不同剂量右美托咪定用于全麻烧伤切痂植皮手术对患者应激指标及炎性因子的影响。方法:选取102例烧伤切痂植皮手术患者的临床资料进行回顾性分析,选取时间为2018年5月-2020年5月,均予以右美托咪定麻醉,按照其麻醉剂量的不同分为低剂量组(0.25μg/kg)、中剂量组(0.5μg/kg)、高剂量组(1.0μg/kg),各34例。对比麻醉诱导前(T_(1))、拔除气管导管前15min(T_(2))、拔除气管导管即刻(T_(3))、拔除气管导管后15min(T_(4))的心率(HR)、平均动脉压(MAP);比较入室时(Ta)、气管插管即刻(Tb)、拔除气管导管即刻(Tc)、拔除气管导管后60min(Td)的肾上腺素(E)、皮质醇(Cor)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白介素-6(IL-6)水平,以及观察镇静评分、躁动评分及麻醉时间。结果:重复测量方差分析显示,三组HR、MAP、E、Cor、TNF-α、IL-10、IL-6的时点、组间、交互比较均存在显著差异(P<0.05)。单因素方差分析显示,T_(1)时刻,三组HR、MAP比较差异无统计学意义(P>0.05);T_(2)、T_(3)、T_(4)时刻,高剂量组的HR、MAP低于低、中剂量组,差异有统计学意义(P<0.05)。Ta时刻,三组E、Cor、TNF-α、IL-10、IL-6水平比较差异无统计学意义(P>0.05);Tb、Tc、Td时刻,高剂量组的E、Cor、TNF-α、IL-10、IL-6低于低、中剂量组,差异有统计学意义(P<0.05)。高剂量组的镇静评分高于低、中剂量组,而躁动评分低于低、中剂量组,差异有统计学意义(P<0.05)。三组麻醉时间相比,差异无统计学意义(P>0.05)。结论:1.0μg/kg右美托咪定用于全麻烧伤切痂植皮手术中效果最为理想,既能减轻应激反应,又能降低炎性因子水平。

Objective To explore the effects of different doses of dexmedetomidine on stress indicators and inflammatory factors in burn patients undergoing escharectomy and skin grafting under general anesthesia.Methods The clinical data of 102 burn patients undergoing escharectomy and skin grafting were selected for retrospective analysis.The selection time is from May 2018 to May 2020.All were anesthetized with dexmedetomidine.According to the different anesthetic doses,they were divided into the low-dose group(0.25μg/kg),the middle-dose group(0.5μg/kg),and the high-dose group(1.0μg/kg),each with 34 cases.The heart rate(HR)and mean arterial pressure(MAP)before anesthesia induction(T_(1)),15 minutes before tracheal catheter removal(T_(2)),immediately after tracheal catheter removal(T_(3)),and 15 minutes after tracheal catheter removal(T_(4))were compared.Compare levels of adrenaline(E),cortisol(Cor)and tumor necrosis factor-α(TNF-α)、Levels of interleukin-10(IL-10)and interleukin-6(IL-6)at admission(Ta),immediately after tracheal intubation(Tb),immediately after tracheal catheter removal(Tc),and 60 minutes after tracheal catheter removal(Td).Observed the sedation score,restlessness score and anesthetic time of the three groups.Results Repeated measures analysis of variance showed that there were significant differences between the three groups of HR,MAP,E,Cor,TNF-α,IL-10,IL-6 in time point,group,and interaction comparison(P<0.05).One-way analysis of variance showed that T_(1),HR and MAP of the three groups were not significantly different(P>0.05).T_(2),T_(3) and T_(4) point,the HR and MAP of the high-dose group were lower than those of the low-dose group and the middle-dose group(P<0.05).Ta point,the three groups of E,Cor,TNF-α,IL-10,IL-6 were not significantly different(P>0.05).Tb,Tc and Td point,E,Cor,TNF-α,IL-10 and IL-6 in the high-dose group was lower than the low-dose group and the middle-dose group(P<0.05).The sedation score of the high-dose group was higher than that of the low and medium-dose groups,while the restlessness score was lower than that of the low-dose group and the middle-dose group(P<0.05).There was no significant difference in the anesthesia time between the three groups(P>0.05).Conclusion 1.0μg/kg dexmedetomidine has the best effect in general anesthesia burns and skin grafting.It can not only reduce the stress response,but also reduce inflammatory factors.