右美托咪定对体外循环手术患儿外周血中性粒细胞凋亡和NF-κB活性的影响  

Effects of dexmedetomidine on apoptosis of polymorphonuclear neutrophils and NF-κB activity in peripheral blood in pediatric patients undergoing cardiopulmonary bypass

作　　者：郭琼梅[1] 刘秀叶 王莉[1] 周晓辉[1] 魏砚砚[1] 毛瑞芬[1] GUO Qiong-mei;LIU Xiu-ye;WANG Li;ZHOU Xiao-hui;WEI Yan-yan;MAO Rui-fen(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,河北石家庄050031

出　　处：《河北医科大学学报》2020年第10期1181-1184,1189,共5页Journal of Hebei Medical University

摘　　要：目的评价右美托咪定对体外循环(cardiopulmonary bypass,CPB)手术患儿外周血中性粒细胞凋亡和核因子κB(nuclear factor-κB,NF-κB)活性的影响。方法选取择期体外循环下行室间隔缺损修补术患儿60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ或Ⅲ级,采用随机数字表法,将患儿分为2组(n=30):对照组(C组)和右美托咪定组(D组),静脉注射咪唑安定0.15 mg/kg,舒芬太尼1μg/kg,依托咪酯0.3 mg/kg,罗库溴铵0.6 mg/kg诱导,麻醉诱导后D组给予初始剂量0.5μg/kg的右美托咪定(给药时间>10 min),继之以0.4μg·kg-1·h-1的速率维持至术毕,C组同样的方法给予等容量生理盐水。分别于给药前(T0)、CPB开始后30 min(T1)、CPB停止后30 min(T2)、CPB停止后4 h(T3)和CPB停止后24 h(T4)采集桡动脉血样,分离中性粒细胞和血浆,检测中性粒细胞NF-κB活性,采用流式细胞术检测中性粒细胞凋亡率和Caspase-3的表达。结果2组患儿中性粒细胞NF-κB活性在T1~4均较T0时升高(P<0.05),D组在T1~4各时间点均低于C组,2组在组间、时点间及组间·时点间交互作用差异均有统计学意义(P<0.05);2组患儿中性粒细胞凋亡率和Caspase-3的表达从T0到T2逐渐降低,T3、T4时升高,但均较T0时降低,D组在T1~4各时间点均高于C组,2组在组间、时点间差异均有统计学意义(P<0.05)。中性粒细胞凋亡率与NF-κB活性呈负相关(C组:r=-0.606,P<0.05;D组:r=-0.691,P<0.05)。结论NF-κB活性的抑制参与了右美托咪定减轻体外循环手术患儿外周血中性粒细胞凋亡抑制的过程。Objective To evaluate the effects of dexmedetomidine on apoptosis of polymorphonuclear neutrophils and nuclear factor-κB(NF-κB)activity in peripheral blood in pediatric patients undergoing cardiopulmonary bypass.Methods Sixty pediatric patients,of American Society of Anesthesiologists(ASA)physical statusⅡorⅢ,scheduled for elective repair of ventricular septal defect under continuous blood purification(CPB),were randomly divided into 2 groups(n=30 each)using a random number table:control group(group C)and dexmedetomidine groups(group D).In group D,dexmedetomidine 0.5μg/kg(initial dose)was given over more than 10 min after anesthesia induction,followed by continuous infusion at 0.4μg·kg-1·h-1,until the end of operation.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration(T0),30min after begainning of CPB,at 30min,4 and 24 h after termination of CPB(T1-4),blood samples were collected for determination of NF-κB activity,apoptosis rate and express of caspase-3 of polymorphonuclear neutrophils.Results Compared with the baseline value at T0,NF-κB activity of polymorphonuclear neutrophils was significantly increased,the value of group D was decreased than that of group C at T1-4,there were statistically significantly difference between groups,time points and their interaction(P<0.05).Apoptosis rate and express of caspase-3 of polymorphonuclear neutrophils were gradually decreased at T0-T2,and then increased at T3,T4,while significantly decreased than that of T0 in two groups,and the value of group D was increased than that of group C at T1-4,there were statistically significantly difference between groups and time points(P<0.05).The apoptosis rate of polymorphonuclear neutrophils was negatively correlated with the activity of NF-κB(group C:r=-0.606,P<0.05;group D:r=-0.691,P<0.05).Conclusion The inhibition of NF-κB activity is involved in the reduction of apoptosis inhibition of polymorphonuclear neutrophils in peripheral blood in pediatric patients undergoi

关 键 词：体外循环 NF-ΚB 儿童 

分 类 号：R654.1[医药卫生—外科学]