不同剂量的右美托咪定对全麻开胸手术患者苏醒期应激反应的影响  

Effects of Dexmedetomidine(Dex)on the Stress Reaction and Inflammatory Cytokines During Resuscitation Period in Patients Undergoing Thoracic Surgery Under General Anesthesia

作　　者：郑勇萍[1] 郭伟[1] 张宗泽[1] 王焱林[1] 彭勉[1] 王成夭[1] 

机构地区：[1]武汉大学中南医院麻醉科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2015年第2期312-316,共5页Medical Journal of Wuhan University

基　　金：湖北省自然科学基金资助项目(编号:2011CDB508)

摘　　要：目的:探讨不同剂量的右美托咪定对全麻开胸手术患者苏醒期应激反应及炎性细胞因子的影响。方法:80例ASAⅠ或Ⅱ级择期全麻开胸手术的患者,随机分为4组(n=20):对照组(A组)、低剂量组(B组)、中剂量组(C组)和高剂量组(D组)。B组、C组和D组麻醉诱导插管前15min分别静脉注射右美托咪定0.25,0.5,1μg/kg,继以0.4μg/(kg·h)持续泵注至手术结束前30min。A组静脉注射等容量的生理盐水。分别于麻醉前(T1),术中拔除气管导管前15min(T2)、拔除气管导管即刻(T3)、拔除气管导管后15min(T4)各时点记录心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO2)。分别抽取5ml静脉血,测血糖,离心分离血浆贮于-70℃保存集中检测。ELISA法检测血浆肾上腺素、去甲肾上腺素、炎性细胞因子IL-6、IL-10水平。观察4组患者不良反应发生情况。结果:与A组比较,B组T2、T3、T4时点MAP、HR、血糖、血浆肾上腺素、去甲肾上腺素、血浆IL-6、IL-10含量差异无统计学意义(P>0.05);C组、D组MAP降低,HR减慢,血糖、血浆肾上腺素、去甲肾上腺素、IL-6含量降低(P<0.05);血浆IL-10水平明显升高(P<0.05)。与A组、B组、C组比较,D组患者心动过缓、低血压的发生较多,且有苏醒延迟的发生(P<0.05)。结论:右美托咪定可能通过降低血浆IL-6含量,升高血浆IL-10水平抑制开胸手术苏醒期应激反应,且中剂量的右美托咪定效果较好,不良反应少。Objective：To investigate the effects of dexmedetomidine（Dex）on the stress reaction and inflammatory cytokines during resuscitation period in patients undergoing thoracic surgery under general anesthesia.Methods：Eighty ASA ⅠorⅡ patients undergoing selective thoracic surgery under general anesthesia were enrolled in this study.The patients were randomly divided into 4groups（n=20）：control group（group A）,low dosage Dex group（group B）,medium dosage group（group C）and high dosage group（group D）.In groups B,C and D,the patients received an intravenous injection of Dex（0.25,0.5,1μg/kg,respectively）15minutes before intubation,and a continuous injection of Dex at a rate of 0.4μg/（kg·h）succeeded until 30 minutes beforethe end of operation;while in group A,physiological saline was used instead of Dex.HR,MAP and SpO2 were observed.Venous blood was collected and separated centrifugally into blood plasma.The levels of norepinephrine（NE）,epinephrine,IL-6and IL-10 were determined before anesthesia（T1）,15 minutes before extubation during the operation（T2）,at the time of extubation（T3）and 15 minutes after extubation（T4）respectively.Side effects were observed.Results：Compared with group A,there is no difference in HR,MAP and the levels of norepinephrine（NE）,epinephrine,IL-6and IL-10 in group B（P0.05）;HR,MAP and the levels of norepinephrine（NE）,epinephrine and IL-6were lower（P0.05）and the levels of IL-10 were higher in groups C and D（P0.05）at the time of T2,T3 and T4.Compared with groups A,B and C,bradycardia,hypotension and delayed resuscitation occurred more frequently in group D（P0.05）.Conclusion：Dexmedetomidine can inhibit stress reaction during resuscitation period in patients undergoing thoracic surgery under general anesthesia,and the mechanism involves the inhibition of blood plasma IL-6activation and the up-regulation of blood plasma IL-10 level.Best effects are obtained when employing medium dosage of dexmedetomidine.

关 键 词：右美托咪定 苏醒期应激反应 炎性细胞因子 

分 类 号：R614.2[医药卫生—麻醉学]