右美托咪定对脊柱手术患者单核细胞-血小板黏附、单核细胞活化功能的影响  

Effects of dexmedetomidine on CD42a^+/CD14^+,HLADR^+/CD14^+ expression in patients undergoing spinal operation

作　　者：沈颖彦[1] 康帅[1] 赵烨钧[1] 周红梅[1] 

机构地区：[1]浙江省嘉兴市嘉兴学院附属第二医院麻醉科,嘉兴314000

出　　处：《中国临床药学杂志》2017年第5期300-304,共5页Chinese Journal of Clinical Pharmacy

基　　金：浙江省嘉兴市科技局资助(编号2014AY21031)

摘　　要：目的探讨右美托咪定对多节段脊柱手术患者单核细胞-血小板黏附、单核细胞活化功能的影响。方法择期在全身麻醉下行多节段脊柱融合手术患者40例,ASAⅠ~Ⅱ级,随机分为右美托咪定(D)组和对照(C)组,每组20例。D组在麻醉诱导前10 min给予右美托咪定0.5μg·kg^(-1)负荷量,后以0.5μg·kg^(-1)·h^(-1)泵注维持直至手术结束前15 min;C组给予等容量生理盐水。于术前基础状态(T_1)、手术开始30 min(T_2)、手术结束后60 min(T_3)、术后1 d(T_4)、术后3 d(T_5)和术后5d(T_6)6个时间点抽血检测单核细胞-血小板黏附(CD42a^+/CD14^+)、单核细胞活化功能(HLADR+/CD14+)的表达以及血浆中WBC、PLT和C反应蛋白(CRP)的含量。结果与C组相比,D组CD42a+/CD14+在T2(17.9±6.0 vs 25.5±9.6)、T3(18.1±6.3 vs 25.0±6.9)、T4(17.3±5.3 vs 22.2±4.9)时刻明显降低(P﹤0.01);HLADR+/CD14+在T4(78.0±9.2 vs65.6±14.5)、T5(78.9±7.0 vs 66.8±15.6)时刻明显升高(P﹤0.01);CRP和WBC在T_2、T_3、T_4、T_5时刻明显降低(P﹤0.01或P﹤0.05)。结论右美托咪定用于脊柱手术具有降低炎症反应以及调节免疫抑制的作用。AIM To investigate effects of dexmedetomidine on CD42a^＋/CD14^＋ ,HLADR^＋/CD14^＋ expres- sion in patients undergoing spinal operation. METHODS Forty ASA I - II patients undergoing spinal operation were randomly divided into 2 groups ： dexmedetomidine group （ group D ） and control group （ group C ） , 20 patients in each group. A loading dose of dexmedetomidine（0.5μg·kg^-1） 10 min before the induction and a continuous dose of dexmedetomidine（0.5 μg·kg^-1·h^-1） was injected intravenously until 15 min before the end of operation in group D. The equal volume of normal saline was given in group C. The serum levels of CD42a^＋/CD14^＋ , HLADR^＋/CD14^＋ , WBC, PLT and CRP were measured in the patients at 10 min before the induction（T1 ） ,30 min （ T2 ） after the beginning of operation and 60 min （ T3 ）, 1 d （ T4 ）, 3 d （ T5 ）, 5 d （ T6 ） after the end of operation. RESULTS Compared with group C, treatment with dexmedetomidine caused a significant decrease in CD42a^＋/ CD14^＋ at T2（17.9 ±6.0 vs 25.5 ±9.6）, T3（18. 1 ±6.3 vs 25.0 ±6.9） and T4（17.3±5.3 vs 22.2 ±4.9） （P 〈 0.01）and an obvious increase in HLADR^＋/CD14^＋ at T4（78.0 ±9.2 vs 65.6 ±14.5） and T5（78.9 ±7.0 vs 66.8 ± 15.6）（P 〈 0.01）. Compared with group C, at T2,T3,T4 and T5,CRP and WBC decreased obviously （P 〈 0.01 or P 〈 0.05）. CONCLUSION Dexmedetomidine can inhibit the inflammatory response and reduce the immunosuppression in patients undergoing spinal operation.

关 键 词：右美托咪定 单核细胞-血小板黏附 单核细胞活化 脊柱手术 

分 类 号：R614[医药卫生—麻醉学]