右美托咪定对急性呼吸窘迫综合征机械通气患者应激反应及免疫平衡的影响  

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome

作　　者：张可祥[1] 周岐龙 刘超[1] 潘鹏飞[1] 邹鑫森[1] 岳希 Zhang Kexiang;Zhou Qilong;Liu Chao;Pan Pengfei;Zou Xinsen;Yue Xi

机构地区：[1]重庆三峡中心医院重症医学科,404000

出　　处：《中国基层医药》2019年第19期2336-2342,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：重庆市万州区科学技术委员会科研项目(042017072).

摘　　要：目的探讨右美托咪定对急性呼吸窘迫综合征(ARDS)机械通气患者应激反应和免疫平衡的影响。方法选择2016年3月至2018年9月重庆三峡中心医院收住的ARDS需机械通气患者90例,采用随机数字表法将患者分为咪达唑仑组(M组,30例)、丙泊酚组(P组,30例)、右美托咪定组(D组,30例),另选取30例该院体检健康职工为正常对照组(C组)。M组、P组、D组在枸橼酸芬太尼镇痛基础上用微量泵入相应药物。观察各组患者于开始镇静治疗前(T0)、6 h(T1)、24 h(T2)、48 h(T3)的心率(HR)、平均动脉压(MAP)、Murray评分、急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)评分、血浆去甲肾上腺素(NS)、血浆皮质醇(Cor)及血T淋巴细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)的变化。C组于检查次日早晨8∶00抽空腹血检测血浆NS、Cor水平及T淋巴细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)。结果M组、P组、D组治疗前心率、MAP、NS、Cor较C组明显升高,差异有统计学意义(t=38.43,P<0.05),CD4^+、CD8^+、CD4^+/CD8^+水平基本都低于C组。M组、P组、D组治疗后心率、MAP与治疗前比较差异有统计学意义(t=13.07、2.92,均P<0.05);P组、D组与M组比较,MAP在24 h、48 h差异有统计学意义(t=13.23,P<0.05)。NS、Cor较治疗前三组比较在治疗24 h、48 h差异有统计学意义(t=2.92,P<0.05);P组、D组与M组比较,P组在48 h时Cor差异有统计学意义(t=26.57,P<0.05);D组与M组比较NS、Cor在治疗24 h、48 h差异均有统计学意义(t=2.35,P<0.05),D组与P组治疗48 hNS、Cor差异有统计学意义(t=2.96,P<0.05)。M组、P组、D组在治疗6 h、24 h时CD4^+、CD8^+、CD4^+/CD8^+进一步下降,M组下降最明显,P组居中,D组下降的幅度最小;P组、D组与M组治疗48 h时CD4^+、CD8^+、CD4^+/CD8^+差异均有统计学意义(t=3.93、5.93,均P<0.05);D组与P组在治疗48 h时比较CD4^+、CD8^+差异有统计学意义(t=2.27,P<0.05)。M组、P组、D组T0时血浆NS、Cor均高于C组(均P<0.05),而CD4+均�Objective To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4^+, CD8^+, CD4^+/CD8^+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4^+, CD8^+, CD4^+/CD8^+) in C group were measured at 8∶00 a. m.the next day. Results The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P<0.05), while the levels of CD4+ were lower than those in C group(all P<0.05). Compared with T0, the plasma NS and Cor decreased at T3 in M, P and D group (all P<0.05). The plasma Cor at T3 in P group was lower than that in M group[(475.77±49.69)μg/L vs.(502.33±60.92)μg/L](t=-26.57, P<0.05). The plasma NS and Cor at T3 in D group were lower than those in M group[(20.64±4.70)ng/L vs.(25.29±4.03)ng/L,(442.83±66.59)μg/L vs.(502.33±60.92)μg/L](t=-4.51,-59.50, all P<0.05), and were lower than those of P group[(20.64±4.70)ng/L vs.(23.60±4.49)ng/L,(442.83±66.59)μg/L vs.(475.77±49.69)μg/L](t=-2.96,-32.93, all P<0.05). Compared with T0, the level of CD4+ decreased at T1, T2 and T3(except T3 in D group) in M, P an

关 键 词：呼吸窘迫综合征 成人 通气机 机械 T淋巴细胞 右美托咪定 丙泊酚 咪达瞠仑 

分 类 号：R614[医药卫生—麻醉学] R563.8[医药卫生—外科学]