右美托咪定对机械通气脓毒症患者炎性因子的影响  

Effects of dexmedetomidine on the inflammatory factors in sepsis patients under mechanical ventilation

作　　者：刘舒畅 庄天时 许铁 卓越 薛婷 叶英 Liu Shuchang;Zhuang Tianshi;Xu Tie;Zhuo Yue;Xue Ting;Ye Ying(Emergency Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China;Graduate School of Xuzhou Medical University, Xuzhou 221004, China;Department of Emergency and Rescue Medicine, Xuzhou Medical University, Xuzhou 221002, China;Jiangsu Provincial Health Emergency Research Institute, Xuzhou 221002, China)

机构地区：[1]徐州医科大学附属医院急救中心,221002 [2]徐州医科大学研究生学院,221004 [3]徐州医科大学急救与救援医学系,221002 [4]江苏省卫生应急研究所,徐州221002

出　　处：《国际麻醉学与复苏杂志》2019年第7期627-630,共4页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省自然科学基金面上项目(BK20161153).

摘　　要：目的 探讨右美托咪定(dexmedetomidine,Dex)对机械通气脓毒症患者炎性因子的影响。 方法 脓毒症行机械通气患者60例,应用随机数字表法将患者分为Dex组和丙泊酚组各30例,分别予Dex和丙泊酚镇静保持患者状态于躁动-镇静评分(Richmond Agitation and Sedation Scale, RASS)-2~0分;两组患者分别于用药前(T0)及用药后24h(T1)、48h(T2)、72h(T3)时抽取静脉血检测血清IL-6、C反应蛋白(C-reactiveprotein,CRP)、降钙素原(procalcitonin,PCT)的水平。比较两组患者接受镇静治疗后第5天、第10天时序贯器官衰竭(Sequential Organ Failure Assessment, SOFA)评分和急性生理学和慢性健康评估Ⅱ(Acute Physiology and Chronic Health Evaluation Ⅱ , APACHE Ⅱ )评分,并统计两组患者不良反应发生率。 结果 两组间患者性别、年龄、SOFA评分、APACHEⅡ评分等基线指标差异均无统计学意义(P>0.05)。治疗前两组患者IL-6、PCT及CRP水平异常升高,治疗后显著下降,与治疗前比较差异有统计学意义(P<0.05);两组患者治疗后第5天和第10天APACHEⅡ评分及SOFA评分较治疗前明显改善,差异有统计学意义(P<0.05);治疗后Dex组患者各时间点IL-6、PCT、CRP水平以及APACHEⅡ评分、SOFA评分明显低于丙泊酚组,差异有统计学意义(P<0.05)。Dex组和丙泊酚组不良反应发生率分别为6.67%、16.67%,差异无统计学意义(P>0.05)。 结论 本试验结果提示Dex和丙泊酚对机械通气脓毒症患者有良好的抗炎作用,Dex抗炎作用较丙泊酚强且不良反应少。Objective To investigate the effects of dexmedetomidine (Dex) on the inflammatory factors in sepsis patients under mechanical ventilation. Methods A total of 60 sepsis patients under mechanical ventilation were enrolled. They were randomly divided into a dexmedetomidine group and a propofol group (n=30), and treated with dexmedetomidine or propofol to maintain a range of -2 to 0 of Richmond Agitation-Sedation Score (RASS). Then, blood samples were taken and the levels of interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were detected before (T0), 24 h (T1), 48 h (T2), and 72 h (T3) after treatment. Both groups were compared for the score of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) on Days 5 and 10 after sedation. Meanwhile, the incidence of adverse reactions in the two groups were calculated. Results There were no significant differences in gender, age, SOFA score, APACHEⅡ score between the two groups (P>0.05). Before treatment, the levels of IL-6, PCT and CRP were abnormally increased, which were remarkable decreased after treatment (P<0.05). The scores of APACHEⅡ and SOFA were significantly improved on Days 5 and 10 after sedation in the two groups(P<0.05). After treatment, the decline of IL-6, PCT, CRP and the scores of APACHEⅡ and SOFA in the dexmedetomidine group were more obvious than that in the propofol group (P<0.05). The incidence of adverse reactions in the dexmedetomidine group and the propofol group were 6.67% and 16.67%, without statistical difference (P>0.05). Conclusions Dex and propofol have good anti-inflammatory effects on sepsis patients under mechanical ventilation. Dex has stronger anti-inflammatory effect and rare adverse reactions.

关 键 词：右美托咪定 丙泊芬 脓毒症 炎性因子 

分 类 号：R459.7[医药卫生—急诊医学]