右美托咪定对体外循环下心内直视手术患儿外周血中性粒细胞NF-κB活性的影响  

Effect of dexmedetomidine on activity of nuclear factor kappa B in peripheral blood neutrophils in pediatric patients undergoing open heart surgery under cardiopulmonary bypass

作　　者：郭琼梅[1] 王莉[1] 张泽[1] 周长浩[1] 田长征[1] Guo Qiongmei;Wang Li;Zhang Ze;Zhou Changhao;Tian Changzheng(Department of Anesthesiology,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院麻醉科,石家庄050031

出　　处：《中华麻醉学杂志》2019年第12期1418-1420,共3页Chinese Journal of Anesthesiology

基　　金：河北省卫计委2016年度医学科学研究重点课题计划(20160197)。

摘　　要：目的评价右美托咪定对体外循环(CPB)下心内直视手术患儿外周血中性粒细胞NF-κB活性的影响。方法择期CPB下行室间隔缺损修补术患儿60例,性别不限,年龄4~8岁,体重10.0~24.5 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):对照组(C组)和右美托咪定组(D组)。麻醉诱导后D组静脉输注初始剂量0.5μg/kg右美托咪定(给药时间>10 min),继之以0.4μg·kg^-1·h^-1速率维持至术毕,C组同样的方法给予等容量生理盐水。分别于给药前(T1)、CPB开始后30 min(T2)、CPB停止后30 min、4和24 h(T3-5)时,采集动脉血样,分离中性粒细胞和血浆,检测中性粒细胞NF-κB活性及血浆TNF-α和IL-8浓度。结果与T1时比较,T2-5时2组中性粒细胞NF-κB活性均升高,T2-4时C组血浆TNF-α和IL-8浓度及D组血浆TNF-α浓度升高,T2,3时D组血浆IL-8浓度升高(P<0.05)。与C组比较,D组T2-5时中性粒细胞NF-κB活性降低,T3,4时血浆TNF-α及IL-8浓度降低(P<0.05)。结论右美托咪定减轻CPB下心内直视手术患儿全身炎症反应的机制与抑制外周血中性粒细胞NF-κB的激活有关。Objective To evaluate the effect of dexmedetomidine on the activity of nuclear factor kappa B(NF-κB)in peripheral blood neutrophils in pediatric patients undergoing open heart surgery under cardiopulmonary bypass(CPB).Methods Sixty pediatric patients of both sexes,aged 4-8 yr,weighing 10.0-24.5 kg,with American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective repair of ventricular septal defect under CPB,were divided into 2 groups(n=30 each)using a random number table method:control group(group C)and dexmedetomidine group(group D).After anesthesia induction,dexmedetomidine was intravenously infused as a bolus of 0.5μg/kg(time for infusion>10 min)followed by an infusion of 0.4μg·kg^-1·h^-1 until the end of surgery in group D,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration,at 30 min after beginning of CPB,and at 30 min,4 h and 24 h after termination of CPB(T1-5),arterial blood samples were collected,and neutrophils and plasma were isolated for determination of NF-κB activity in neutrophils and concentrations of tumor necrosis factor-a(TNF-α)and interleukin-8(IL-6)in plasma.Results Compared with the baseline value at T1,the activity of NF-κB in neutrophils was significantly increased at T2-5 in two groups,the plasma concentrations of TNF-αand IL-8 were significantly increased at T2-4 in group C(P<0.05),and the plasma TNF-αconcentration at T2-4 and IL-8 concentration at T2-3 were significantly increased in group D(P<0.05).Compared with group C,the activity of NF-κB in neutrophils was significantly decreased at T2-5(P<0.05),and the plasma TNF-αand IL-8 concentrations were decreased at T3-4 in group D(P<0.05).Conclusion The mechanism by which dexmedetomidine reduces systemic inflammatory response is related to inhibiting the activation of NF-κB in peripheral blood neutrophils in pediatric patients undergoing open heart surgery under CPB.

关 键 词：右美托咪啶 中性粒细胞 NF-ΚB 心肺转流术 炎症 

分 类 号：R726[医药卫生—儿科]