右美托咪定对严重烧伤患者围术期炎症因子的影响  

Effect of dexmedetomidine on inflammatory cytokines of severely burned patients during perioperative period

作　　者：朱志鹏[1] 周红梅[1] 路建[1] 杜炎芳[1] 

机构地区：[1]浙江省嘉兴市第二医院麻醉科,314000

出　　处：《中华全科医学》2015年第12期1944-1946,共3页Chinese Journal of General Practice

摘　　要：目的 探讨右美托咪定对严重烧伤行削痂植皮术患者围术期炎症因子浓度变化的影响及其意义。方法择期拟行切痂植皮术的体表烧伤患者30例,ASA分级Ⅱ或Ⅲ级,性别不限,年龄25~55岁,体重45~80 kg。随机数字表法分为2组（n=15）：对照组（C组）和右美托咪定组（D组）。麻醉诱导前,D组经10 min静脉输注右美托咪定0.6μg/kg,后持续静脉泵注0.3μg/（kg·h）维持至术毕前30 min,C组采用同样方法静脉输注等容量生理盐水。2组均采用相同的静吸复合全麻。分别于诱导前、术毕、术后12 h和术后24 h测定血浆白细胞介素-6（IL-6）、白细胞介素-10（IL-10）和肿瘤坏死因子-α（TNF-α）浓度。结果 所有患者围术期炎症因子浓度均逐渐增高,右美托咪定组术毕、术后12 h和术后24 h的TNF-α为（39.7±7.4、39.3±6.5、41.9±7.3）pg/ml,IL-6为（35.5±6.4、37.6±4.6、47.4±7.0）pg/ml,较对照组术毕、术后12 h和术后24 h的TNF-α（49.8±9.6、59.5±8.5、68.8±11.4）pg/ml,IL-6（42.2±5.3、46.3±7.5、59.2±11.3）pg/ml均明显降低;而右美托咪定组术后12 h和术后24 h的IL-10（26.3±5.9、48.4±8.7）pg/ml,较对照组（17.6±5.0、34.2±7.7）pg/ml显著升高,2组差异有统计学意义（P〈0.01）。结论 右美托咪定能显著减轻严重烧伤行削痂植皮术患者围手术期炎性反应,具有一定的炎症调节作用。Objective To explore the effect of dexmedetomidine（ dex） on the inflammatory cytokines levels in severely burned patients undergoing escharotomy and skin grafting. Methods Thirty ASA Ⅱ or Ⅲ severely burned patients,aged25-55 years,weighing 45-80 kg,scheduled for elective surgical excision and grafting of burns were randomly assigned into two groups（ n = 15 each） ： The control group（ group C） and dex group（ group D）. The anesthesia was induced by transvenous infusion of 0. 6 μg / kg dex during 10 min before the opration in group D,then continuous intravenous infusion of 0. 3 μg /（ kg·h） maintained until 30 min before the end of surgery. The same volume of saline was infused in group C,the operations of the both groups were conducted with inhalation anesthesia. The arterial blood was drawn before induction,at the end of surgery,12 h of postoperative,and 24 h of postoperative operation. The plasma interleukin-6（ IL-6）,interleukin（ IL-10） and tumor necrosis factora（ TNF-α） levels were determined at each time point. Results All perioperative inflammatory cytokines levels were increased gradually. The serum TNF-αof group D were（ 39. 7 ± 7. 4,39. 3 ± 6. 5,41. 9 ± 7. 3） pg / ml,IL-6（ 35. 5 ± 6. 4,37. 6 ± 4. 6,47. 4 ± 7. 0） pg / ml,significantly lower than the TNF-α of group C（ 49. 8 ± 9. 6、59. 5 ± 8. 5、68. 8 ± 11. 4） pg/ml,IL-6（ 42. 2 ± 5. 3,46. 3 ± 7. 5,59. 2 ± 11. 3） pg/ml,at the end of surgery,12 h of postoperative,and 24 h of postoperative operation. However,The levels of IL-10 of group D at 12 h of postoperative and 24 h of postoperative operation were（ 26. 3 ± 5. 9,48. 4 ± 8. 7） pg / ml,which were significantly higher than that of group C（ 17. 6 ± 5. 0,34. 2 ± 7. 7） pg / ml,the differences were statistically significant（ P〈0. 01）. Conclusion Dexmedetomidine can significantly reduce the perioperative inflammatory response to patients undergoing escharotomy and skin grafting,with some inflammation regulation.

关 键 词：右美托咪定 烧伤 切痂植皮术 炎症 

分 类 号：R644[医药卫生—外科学] R614.2[医药卫生—临床医学]