右美托咪定对腰椎融合术围术期炎性细胞因子的影响  

Effects of dexmedetomidine on inflammatory responses in patients undergoing lumbar spinal fusion

作　　者：黄小静[1] 姚军[2] 尚嘉伟[2] 黄同飞 汪正平[3] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,上海200080 [2]上海交通大学附属第六人民医院麻醉科 [3]同济大学附属第十人民医院麻醉科

出　　处：《上海医学》2014年第2期105-109,共5页Shanghai Medical Journal

摘　　要：目的观察术中应用右美托咪定对腰椎融合术围术期炎性细胞因子水平的影响，并探讨其可能的抗炎机制。方法选择择期行腰椎融合术的患者60例，麻醉诱导后随机分入右美托咪定组和对照组。右美托咪定组患者静脉注射右美托咪定0．75ug／kg，对照组患者给予等容量的0．9％氯化钠溶液。比较两组患者麻醉诱导前（T0）、给予右美托咪定或0．9％氯化钠溶液后（T1）、给药30min后（T2）各时间点的平均动脉压（MAP）和心率（HR），以及术中和术后麻醉镇痛药的用量。分别于T0、术后进入麻醉后恢复室即刻（T3）、术后18～20h（T4）各时间点抽取患者外周静脉血，采用酶联免疫吸附试验测定促炎性细胞因子高迁移率族蛋白B1（HMGB1）、白细胞介素（IL）-6、核转录因子（NF）-kB和抗炎性细胞因子IL-10的水平。结果两组间手术时间和术中维库溴铵、芬太尼、丙泊酚、七氟烷用量的差异均无统计学意义（P值均〉0．05）。两组间各时间点的MAP和HR的差异均无统计学意义（P值均〉0．05），两组在T1、T2时间点的MAP和HR均显著低于同组T0时间点（P值均〈0．05）。两组间术后2、4、8、12、24、48h的疼痛视觉模拟评分（VAS评分）的差异均无统计学意义（P值均〉0．05）。两组间各时间点NF-kB水平的差异均无统计学意义（P值均〉0．05），右美托眯定组在T3时间点的NF-kB水平显著低于同组T0时间点（P〈0．05），对照组各时间点NF-kB水平的差异均无统计学意义（P值均〉0．05）。两组间和两组内各时间点的HMGB1、IL-10水平的差异均无统计学意义（P值均〉0．05）。右美托咪定组在T4时间点的IL-6水平显著高于同组T0时间点（P〈0．05），T3、T4时间点的IL-6水平显著低于对照组同时间点（P值均〈0．05）；对照组T3、T4时间点的IL-6水平显著高于同组T0时间点（P值均〈0．05），T4时间点Objective To observe the effect of dexmedetomidine on perioperative inflammatory responses during lumbar spinal fusion, and to explore its possible anti-inflammatory mechanism. Methods Sixty patients undergoing lumbar spinal fusion were enrolled in the study and randomly divided into two groups （n = 30）. After induction of anesthesia, patients in dexmedetomidine group received a loading dose of dexmedetomidine （0.75 ug/kg） and patients in control group received the same dose of normal saline. Intraoperative mean arterial pressure （MAP） and heart rate （HR） were compared between the two groups at three time points： before anesthesia induction （T0）, at the end of the administration of dexmedetomidine and normal saline （T1）, and 30 min after the administration （T2）. The consumption of anesthetics was also compared between the groups. The proinflammatory cytokines, such as high mobility group box 1 （HMGB1）, interleukin （IL）-6, and nuclear factor-kappa B （NF-KB）, and anti-inflammatory cytokine IL-10 were quantified by sandwich enzyme-linked immunoassay （ELISA） at three time points： To, at the end of surgery （T3） and 18- 20 hours after surgery （T4）. Results There were no significant differences in terms of operative time or consumption of vecuronium, fentanyl, propofol or sevoflurane between the two groups （all P〉0.05） ; neither were the intraoperative MAP and HR （all P〉0.05）. Compared with the baseline, MAP and HR at T1 and T2 were significantly decreased in all patients （all P〈0.05）. There were no significant differences in visual analog scale （VAS） scores at 2 h, 4 h, 8 h, 12 h, 24 h or 48 h after surgery between the two groups （all P〉0.05）. The NF-KB level at T3 was significantly lower than that at To in the dexmedetomidine group （P〈0.05）; however, there was no significant difference in the NF-KB level at each time point in the control group （all P〉0.05）. The HMGB1 and IL-10 levels were not statistically different betwe

关 键 词：右美托咪定 高迁移率族蛋白1 核转录因子-KB a2肾上腺素能受体 腰椎融合术 

分 类 号：R614[医药卫生—麻醉学]