右美托咪定对重症颅脑损伤患者围术期血浆S蛋白100B及炎性细胞因子的影响  

Effects of dexmedetomidine on S-100B and inflammatory cytokines of plasma in patients with serious brain injury

作　　者：许忠玲[1] 范冰冰[2] 郭华[3] 徐兴国[1] 

机构地区：[1]南通大学附属医院麻醉科,南通市226001 [2]南通大学医学院 [3]南通大学附属医院分院

出　　处：《临床麻醉学杂志》2012年第9期872-874,共3页Journal of Clinical Anesthesiology

基　　金：南通市市级科研基金(S2010052)

摘　　要：目的观察全麻期间持续应用右美托咪定对重症颅脑损伤患者围术期血浆S蛋白100B(S-100B)、肿瘤坏死因子(TNF-α)及白细胞介素-6(IL-6)的影响。方法重症颅脑外伤患者40例,随机均分为右美托咪定组(D组)和对照组(C组)。两组分别于麻醉诱导前(T0)、气管插管即刻(T1)、术毕(T2)、术后1d(T3)及3d(T4)晨抽取静脉血,测定S-100B、TNF-α和IL-6水平,同时监测各时点血流动力学的变化情况。结果与T0时比较,T1～T4时D组HR明显减慢,MAP明显降低(P<0.05),T1、T2时C组HR明显增快,MAP明显升高(P<0.05),T3、T4时HR明显减慢,MAP明显降低(P<0.05);T1～T4时D组HR明显慢于C组,T1、T2时MAP明显低于C组(P<0.05)。与T0时比较,T4时D组血浆S-100B明显降低(P<0.05),T2、T3时C组S-100B明显升高(P<0.05)。T3、T4时C组血浆S-100B明显高于D组(P<0.05)。T1～T3时C组血清TNF-α和IL-6明显高于T0时和D组(P<0.05)。C组患者中1例因并发神经源性肺水肿死亡。结论全麻期间持续应用右美托咪定可减缓重症颅脑损伤患者围术期血浆S-100B、血清TNF-α和IL-6浓度的升高,维持血流动力学稳定,减少应激反应。Objective To explore the effects of dexmedetomidine on S protein 100 B （S-100B）, TNF-α and IL-6 of plasma in patients with serious brain injury. Methods Forty patients with serious brain injury were randomly assigned to 2 groups （n= 20 each）： dexmedetomidine group （group D） and control group（group C）. Blood samples were taken immediately before induction of anesthesia （T0）, immediately after tracheal intuhation（T1 ）, immediately after operation（T2 ） day 1 （T3） and day 3（T4） after operation for deterraining the levels of S-100B,TNF-α,IL 6 and monitoring the changes of bemodynamic parameters in each point. Results Compared with those at T0, HR and MAP in group D were significantly decreased at T1 -T4, HR and MAP in group C were increased at T1 ,T2 while decreased at T3 ,T4 （P〈0. 05）. HR in group D were slower than in group C at T2-T4 and MAP were lower at T1 ,T2 （P 〈0. 05）. Compared with To, the level of plasma S-100B in group D were higher at T4, and S-100B in group C were lower at T2 ,T3 （P〈0. 05） ,and group C was higher than group D at T3 ,T4 （P〈0. 05）. The level of TNF-α and IL-6 in group C at T1 -T3 were higher than at T0 （P〈0. 05）. Group C patients due to a case of neurogenic pulmonary edema associated with death. Conclusion Continued application of dexmedetomidine can effectively decrease the levels of plasma S-100B and serum TNF-α,IL-6 in patients with serious brain injury, inhibiting the peri-operative stress resoonse.

关 键 词：右美托咪定 重症颅脑损伤 S-100B TNF-α IL-6 

分 类 号：R614[医药卫生—麻醉学]