右美托咪定对单肺通气患者血清TNF-a、IL-6和IL-10变化的影响  

Effects of dexmedetomidine on perioperative serum TNF-α,IL-6 and IL-10 levels in patients undergoing general anesthesia with one-lung ventilation

作　　者：罗颖[1] 孙建良[1] 吴艳辉[1] 徐丽慧[1] 丁卫华[1] 

机构地区：[1]杭州市第一人民医院麻醉科,310006

出　　处：《浙江医学》2014年第4期300-302,共3页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划(2011KYB064)

摘　　要：目的：观察右美托咪定对单肺通气患者血清TNF-α、IL-6和IL-10变化的影响。方法选择择期全麻单肺通气下行开胸手术患者48例，采用随机数字表法分为右美托咪定组（D组）和对照组（C组），各24例。D组麻醉诱导前10 min经静脉输注右美托咪定1滋g/kg，随后以0.5滋g/（kg·h）的速率输注至术毕前30min。C组给予等量0.9%氯化钠溶液。于麻醉诱导前（T0）、单肺通气即刻（T1）、单肺通气30min（T2）、单肺通气90min（T3）、双肺通气后30 min（T4）和术后120min（T5）时间点采用酶联免疫吸附法测定血清TNF-α、IL-6和IL-10浓度，同时观察HR、MAP、SpO2的变化。结果两组患者各时点HR、MAP、SpO2差异均无统计学意义（均P＞0.05）。与T0时比较，两组患者T2～T5时血浆TNF- α和IL-6浓度升高（P＜0.05），与 C组比较，D组T2～T5时血浆TNF- a和IL-6浓度降低（P＜0.05）。与T0时比较，两组患者T3～T5时血浆IL-10浓度升高（P＜0.05），两组IL-10浓度的差异无统计学意义（P＞0.05）。结论围手术期静脉持续输注右美托咪啶可降低炎性因子TNF-α和IL-6的释放，明显减轻单肺通气患者围术期的炎性反应。Objective To investigate the effects of dexmedetomidine on perioperative serum TNF- α, IL- 6 and IL- 10 levels in patients undergoing general anesthesia with one lung ventilation （OLV）. Methods Forty- eight patients who scheduled for thoracic surgery under general anesthesia with one lung ventilation were randomly divided into two groups （n=24 in each group）：patients in group D were infused with dexmedetomidine 1μg/kg in 10min before anesthesia induction, and then infused at a rate of 0.5μg/ （kg·h） until 30 min before the end of operation;patients in group C received the equal volume of normal saline. Blood samples were col ected before induction of anesthesia（T0）, at beginning of OLV（T1）, 30min （T2） and 90min （T3） after OLV, at 30min after two lung ventilation （T4） and at 120min after operation （T5）. Serum TNF- α IL- 6 and IL- 10 levels were determined at above time points, and HR, MAP and SpO2 were monitored. Results There were no significant differences in HR, MAP and SpO2 between two groups（P〉0.05）. Compared with T0, serum TNF- αnd IL- 6 concentrations were significantly increased at T2~T5 in two groups （P〈0.05）.Compared with group C, serum TNF- αnd IL- 6 concentrations were significantly decreased at T2~T5 in group D （P〈0.05）. Compared with T0, serum IL- 10 concentrations were significantly increased at T3-T5 in the two groups （P〈0.05）. There was no significant difference in concentrations of serum IL- 10 between group C and group D （P〉0.05）. Conclusion Perioperative continuous infusion of dexmedetomidine can decrease serum TNF- αand IL- 6 levels, and reduce inflammatory response in patients undergoing general anesthesia with one- lung ventilation.

关 键 词：右美托咪定 肿瘤坏死因子 白细胞介素- 6 白细胞介素- 10 单肺通气 INTERLEUKIN 6 Inte rleukin 10 

分 类 号：R614[医药卫生—麻醉学]