右美托咪定对经皮肾镜碎石术患者炎症因子的影响  

Effect of dexmedetomidine on inflammatory factors in patients undergoing percutaneous nephrolithotomy

作　　者：曾涟[1] 谭宝乐 阳丽云[1] 陆红文 ZENG Lian;TAN Baole;YANG Liyun;LU Hongwen(Department of Anaesthesiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院麻醉科

出　　处：《右江医学》2019年第5期343-347,共5页Chinese Youjiang Medical Journal

基　　金：2014年广西急诊与医学救援人才高地;广西高校急诊医学重点实验室开放性课题(GXJZ201401)

摘　　要：目的 探讨静脉输注右美托咪定对经皮肾镜碎石术患者围术期血清炎症因子水平的影响。方法 选择全身麻醉经皮肾镜碎石术患者60例,随机分为2组:右美托咪定组(D组)和对照组(C组),每组30例。D组:麻醉诱导开始以0.4μg/(kg·h)的速率泵注右美托咪定至手术结束前30min停止。C组:相同时点和速率泵注生理盐水。根据BIS值调整瑞芬太尼和丙泊酚的用量。记录患者年龄、性别比、身高、体重、ASA分级、灌注碎石时间、麻醉时间、灌注液总量等基本情况。抽取静脉血,用酶联免疫吸附法(ELISA)测定麻醉诱导前(T0)、灌注碎石30min(T1)、灌注碎石术毕(T2)、术后4小时(T3)、术后24小时(T4)的TNF-α、IL-6、IL-10的浓度。结果 两组患者年龄、性别比、身高、体重、ASA分级、灌注碎石时间、麻醉时间、灌注液总量等指标比较差异无统计学意义(P>0.05)。两组患者T0时点TNF-α、IL-6、IL-10浓度差异无统计学意义(P>0.05)。与T0时点比较,两组T1、T2、T3、T4的TNF-α、IL-6及IL-10浓度均显著升高(P<0.05)。与C组比较,D组T1、T2、T3、T4时TNF-α浓度均显著降低(P<0.05),T2、T3、T4时IL-6浓度均显著降低(P<0.05),T2、T3、T4时IL-10浓度显著升高(P<0.05)。结论 围术期静脉输注右美托咪定能减轻经皮肾镜碎石术患者的炎症反应,降低促炎因子TNF-α、IL-6的表达,提高抗炎因子IL-10的表达。Objective To investigate the effect of intravenous infusion of dexmedetomidine on the levels of inflammatory factors in patients undergoing percutaneous nephrolithotomy. Methods A total of 60 patients undergoing percutaneous nephrolithotomy under general anesthesia were selected,and they were randomly divided into dexmedetomidine group(group D) and control group(group C),with 30 cases in each group.The group D were given the injection of dexmetomidine at a rate of 0.4 μg/(kg·h) at the beginning of anesthesia induction and stopped 30 min before the end of the operation,while the group C were intravenously injected with an equal rate of physiological saline at the same time point.The doses of propofol and remifentanil were adjusted according to BIS values during the surgery.And then,basic information of the patients such as age,sex ratio,height,weight,ASA classification,perfusion lithotripsy time,anaesthesia time and total amount of perfusion fluid were recorded.In addition,venous blood were taken,and the concentrations of TNF-a,IL-6 and IL-10 before induction of anesthesia(T 0),at 30 min after the start of lithotripsy(T 1),at the end of lithotripsy(T 2),at 4 hours after the end of surgery(T 3) and 24 hours after the end of surgery(T 4) were measured by enzyme-linked immunosorbent assay(ELISA). Results There were no statistically significant differences between indexes of the patients such as age,sex ratio,height,weight,ASA classification,perfusion lithotripsy time,anaesthesia time and total amount of perfusion fluid between the two groups( P >0.05).There were no statistically significant differences in the concentrations of TNF-α,IL-6 and IL-10 between the two groups at T 0( P >0.05),while the TNF-α,IL-6 and IL-10 concentrations significantly increased in the two groups at T 1,T 2,T 3 and T 4 compared with those at T 0(P<0.05).Compared with that in the group C,the concentration of TNF-α significantly decreased in the group D at T 1,T 2,T 3 and T 4 ( P <0.05),the concentration of IL-6 significantly decreased a

关 键 词：右美托咪定 经皮肾镜碎石术 炎症因子 TNF-Α IL-6 IL-10 

分 类 号：R614.24[医药卫生—麻醉学]