右美托咪定对脓毒症患者免疫调节的影响研究  

Effects of dexmedetomidine on immune regulation in patients with sepsis

作　　者：庞凌霄[1] 蔡文伟[1] 张美齐[1] 沈晔[1] 费敏[1] PANG Ling-xiao;CAI Wen-wei;ZHANG Mei-qi;SHEN Ye;FEI Min(Zhejiang Province People＇s Hospital （People＇s Hospital of Hangzhou Medical College）, Hangzhou, Zhejiang 310014, China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)急诊科,浙江杭州310014

出　　处：《中华医院感染学杂志》2018年第12期1791-1794,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(2014KYB277)

摘　　要：目的探讨右美托咪定对脓毒症患者免疫调节的影响。方法选取2015年6月-2016年5月医院急诊重症监护室(EICU)收治的82例脓毒症患者为研究对象。随机分为试验组与对照组,各41例,试验组予右美托咪定治疗,对照组予咪达唑仑治疗。观察两组患者治疗前后急性生理和慢性健康评分系统(APACHEⅡ)评分;两组患者治疗前、后7天外周血T淋巴细胞数的变化;治疗前、后7天血浆白细胞介素-1(IL-1)、IL-6、IL-10及肿瘤坏死因子-α(TNF-α)。结果治疗后,两组患者APACHEⅡ评分较治疗前均下降,其中试验组为(12.56±2.44)分低于对照组(17.95±3.62)分(P=0.037);治疗后7天,试验组CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+分别为(67.25±13.64)%、(40.36±6.27)%、(39.13±7.46)%、(1.54±0.38)均高于对照组(P<0.05);治疗后,试验组IL-1、IL-6为(9.84±1.48)ng/L、(24.53±5.95)ng/L低于对照组(P=0.032、0.046);而IL-10为(74.32±8.32)pg/ml高于对照组(P=0.043),但试验组TNF-α为(0.71±0.09)μg/L低于对照组,但差异无统计学意义(P=0.076)。结论右美托咪定有镇痛、镇静的作用,能有效改善脓毒症患者的免疫调节功能,减轻炎性反应,对患者的预后有益。OBJECTIVE To investigate the effects of dexmedetomidine on immune regulation in patients with sepsis.METHODS A total of 82 patients with sepsis admitted to our hospital from Jun.2015 to May 2016 in the emergency intensive care unit（EICU）were selected as the subjects of this study,and were randomly divided into experimental group and control group,with 41 cases in each group.The experimental group was treated with dexmedetomidin,and the control group was treated with midazolam.The APACHEⅡ scores before and after treatment between the two groups were observed.The changes of T lymphocyte counts in the peripheral blood,plasma interleukin-1（IL-1）,IL-6,IL-10 and tumor necrosis factor-α（TNF-α）of the two groups before and after 7 days of the treatment were investigated.RESULTS After treatment,the APACHEⅡ scores of both groups decreased to some extent.The APACHEⅡscore of the experimental group was（12.56±2.44）points,which was significantly lower than（17.95±3.62）points of the control group（P=0.037）.After 7 days of treatment,the levels of CD3＋,CD4＋,CD8＋,and CD4＋/CD8＋in the experimental group were（67.25±13.64）%,（40.36±6.27）%,（39.13±7.46）%,and（1.54±0.38）%,which were significantly higher than those in the control group（P〈0.05）.After treatment,IL-1 and IL-6 in the experimental group were（9.84±1.48）ng/L and（24.53±5.95）ng/L,which were significantly lower than those in the control group（P=0.032,0.046）.The IL-10 level was（74.32±8.32）pg/ml,which was significantly higher than the control group（P=0.043）,but the TNF-αlevel in the experimental group was（0.71±0.09）μg/L,which was lower than that in the control group,but the difference was not significant（P=0.076）.CONCLUSIONDexmedetomidine has analgesic and sedative effects,and can effectively improve the immune function of patients with sepsis,reduce inflammatory response,which is beneficial to the prognosis of patients.

关 键 词：右美托咪定 脓毒症 免疫调节 炎性反应 

分 类 号：R459.7[医药卫生—急诊医学]