右美托咪定复合氯胺酮对体外循环患者TNF-a、IL-6、IL-1β、NGAL的影响  

Effect of dexmedetomidine combined ketamine on serum TNF-a,IL-6,IL-1β and NGAL level after cardiopulmonary bypass

作　　者：陈文迪[1] 吴秀娟[2] 张源[1] 仲俊峰[1] 吕安庆[1] 陈忠华[1] 蒋宗明[1] 

机构地区：[1]浙江省绍兴市人民医院(浙江大学绍兴医院)麻醉科 [2]浙江省绍兴市人民医院(浙江大学绍兴医院)肾内科

出　　处：《中国临床药理学与治疗学》2016年第5期567-571,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的:探讨右美托咪定复合亚麻醉剂量氯胺酮对体外循环(CPB)患者急性肾损伤(AKI)的影响。方法:择期CPB下行心脏手术患者100例,按照随机数字表分为4组(n=25):对照组(C组)、右美托咪定组(D组)、氯胺酮组(K组)和复合组(DK组)。麻醉维持采用七氟烷复合丙泊酚靶控输注,维持平均动脉压于65~70 mm Hg。麻醉成功后D组经静脉给予右美托咪定1.0μg/kg(大于10 min),随后以0.5μg·kg^(-1)·h^(-1)泵注至术毕前30 min;K组予氯胺酮0.5 mg/kg静脉注射;DK组静脉予氯胺酮0.5 mg/kg和右美托咪定1.0μg/kg(大于10 min),随后以0.5μg·kg^(-1)·h^(-1)泵注右美托咪定至术毕前30min。麻醉成功后(T_0)、CPB结束(T1)、手术结束(T_2)和术后6 h(T_3)、12 h(T_4)采静脉血,ELISA法测定血清IL-6、TNF-a和IL^(-1)β;定量ELISA法测定血清中性粒细胞明胶酶相关载脂蛋白(NGAL)。结果:与C组比较,D组、K组和DK组TNF-a和IL^(-1)β浓度T2、T3时均降低(P﹤0.05);与D组比较,DK组T2和T_3时TNF-a和IL^(-1)β均显著降低(P﹤0.01)。与C组比较,D组、K组和DK组T_2、T_3和T_4时血NGAL水平均下降(P﹤0.01);与K组比较,DK组T_3时血NGAL水平降低(P﹤0.05)。血NGAL水平与IL-6、IL^(-1)β浓度显著相关(P﹤0.05)。结论:亚麻醉剂量氯胺酮0.5 mg/kg复合右美托咪定1μg/kg给予,随后持续右美托咪定0.5μg·kg^(-1)·h^(-1)泵注能显著减轻心脏手术患者CPB期间炎症反应,降低血NGAL水平,减少AKI。AIM：To evaluate the combining effect of dexmedetomidine and sub-anesthetic dose of ketamine on systemic inflammation and postoperative kidney injury after cardiopulmonary bypass （CPB）.METHODS：100 ASA physical status Ⅱ or Ⅲ patients,aged 40-70 years,scheduled for cardiac surgery were recruited and randomly allocated into four groups （n =25 each）：control group （Group C）,dexmedetomidine group （Group D）,ketamine group （Group K） and combined group（Group DK）.Four groups were proceeded under the same anesthetic induction protocol as inhaled sevoflurane and propofol under target controlled infusion （TCI） were used for anesthesia maintenance.The mean arterial pressure was maintained between 65 to 70 mm Hg during perioperative period.A loading dose of 1.0 μg/kg dexmedetomidine was injected （over 10 minutes）,followed by a continuous infusion of 0.5 μg · kg-1 · h-1 dexmedetomidine to 30 minutes before the completion of surgery in Group D.0.5 mg/kgketamine was intravenously administered after endotracheal intubation in Group K.A loading dose of 1.0 μg/kg dexmedetomidine and 0.5 mg/kg ketamine was injected （over 10 minutes）,followed by a continuous infusion of 0.5μg · kg-1 · h-1 dexmedetomidine to 30 minutes before the completion of surgery in Group DK.Blood samples were extracted at the following time points：after anesthesia induction（T0）,end of CPB（T1）,end of surgery（T2）,6 h（T3） and 12 h（T4） after surgery.Serum levels of IL-6,TNF-a,IL-1β were measured by ELISA,and serum neutrophil gelatinase associated lipocalin （NGAL） level was assayed by quantitative ELISA.RESULTS：Compared with Group C,Group K,D and DK had lower levels of serum TNF-a and IL-1β in T2 and T3 （P 〈 0.05）.Group DK had decreased concentrations of serum TNF-a and IL-1 β in T2 and T3,compared to Group D （P 〈 0.01）.Compared with Group C,Group K,D and DK had lower levels of serum NGAL in T2,T3 and T4 （P 〈 0.01）.Serum NGAL level in T3 of Group DK was lower than that

关 键 词：右美托咪定 氯胺酮 体外循环 炎症反应 急性肾损伤 

分 类 号：R614.1[医药卫生—麻醉学]