右美托咪定对不停跳冠脉旁路移植患者血浆晚期糖基化终末产物受体的影响  

Effect of dexmedetomidine on plasma rage in patients with off-pump coronary artery bypass grafting

作　　者：吕冰风 胡杰[2,3] 李斌 陈兴澎 Lv Bingfeng;Hu Jie;Li Bin;Chen Xingpeng(Xinxiang Medical College,Xinxiang 453003,China;Department of Anesthesiology,Luoyang Central Hospital,Luoyang 471009,China;Luoyang Clinical Research Center of Cardiothoracic Surgery,Luoyang 471009,China;Department of Cardiac Surgery,Luoyang Central Hospital,Luoyang 471009,China)

机构地区：[1]新乡医学院,453003 [2]洛阳市中心医院麻醉科,471009 [3]洛阳市心胸外科疾病临床研究中心,471009 [4]洛阳市中心医院心外科,471009

出　　处：《中华实验外科杂志》2020年第12期2329-2331,共3页Chinese Journal of Experimental Surgery

基　　金：河南省医学科技攻关计划项目(2018020904);河南省科技发展计划项目(192102310128)。

摘　　要：目的观察右美托咪定对不停跳冠脉旁路移植患者血浆晚期糖基化终末产物受体(RAGE)信号通路的影响。方法30例接受不停跳冠状动脉旁路移植术患者随机均分为右美托咪定组和对照组,两组静脉全身麻醉诱导,以静脉泵入丙泊酚、舒芬太尼麻醉维持,间断静脉注射顺阿曲库铵。右美托咪定组于麻醉诱导前静脉泵入右美托咪定1.0μg/(kg·h)10 min后,持续静脉泵入右美托咪定0.5μg/(kg·h)维持,对照组同期给以等量生理盐水,于T1(麻醉诱导后)、T2(吻合血管前)、T3(术后6 h)、T4(术后24 h)、T5(术后48 h)5个时间点采集颈内静脉血3 ml,采用酶联免疫吸附法测定血浆高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)、RAGE浓度。组间数据比较采用t检验,分类变量比较采用χ^2检验。结果右美托咪定组血浆HMGB1、RAGE水平在T5点低于对照组:HMGB1[(189.81±35.89)pg/ml比(265.92±49.48)pg/ml,P<0.01],RAGE[(230.56±64.84)pg/ml比(316.24±126.73)pg/ml,P<0.05];右美托咪定组血浆IL-6水平在T4点低于对照组[(38.03±6.31)pg/ml比(55.81±21.48)pg/ml,P<0.01]。结论右美托咪定对不停跳冠脉旁路移植术中,通过降低HMGB1、RAGE水平,抑制RAGE介导的核因子-κB(NF-κB)炎症通路,发挥抗炎作用。Objective To investigate the effect of dexmedetomidine on the receptor(RAGE)signal pathway of plasma receptor for advanced glycation end products(RAGE)in patients with off-pump coronary artery bypass grafting.Methods Thirty patients undergoing off-pump coronary artery bypass grafting were randomly divided into dexmedetomidine group and control group.Anesthesia was induced by intravenous infusion of propofol and sufentanil,and intermittent intravenous injection of cisatracurium.In dexmedetomidine group,dexmedetomidine[1.0μg/(kg·h)]was infused intravenously for 10 min before anesthesia induction,and then 0.5μg/(kg·h)was continuously pumped into dexmedetomidine group for maintenance.The control group was given the same amount of normal saline at the same time,3 ml of internal jugular vein blood was collected at T1(after anesthesia induction),T2(before vascular anastomosis),T3(6 h after operation),T4(24 h after operation)and T5(48 h after operation),The concentrations of high mobility group protein B1(HMGB1),interleukin(IL)-6 and rage in plasma were measured by enzyme linked immunosorbent assay(ELISA).Results The plasma levels of HMGB1 and rage in dexmedetomidine group were lower than those in control group at T5:HMGB1[(189.81±35.89)pg/ml vs.(265.92±49.48)pg/ml,P<0.01],rage[(230.56±64.84)pg/ml vs.(316.24±126.73)pg/ml,P<0.05];Plasma IL-6 level in dexmedetomidine group was lower than that in control group at T4[(38.03±6.31)pg/ml vs.(55.81±21.48)pg/ml,P<0.01].Conclusion Dexmedetomidine plays an anti-inflammatory role in off-pump coronary artery bypass grafting by reducing the levels of HMGB1 and rage and inhibiting rage mediated nuclear factor-κB(NF-κB)inflammatory pathway.

关 键 词：右美托咪定 冠脉旁路移植 晚期糖基化终末产物受体 

分 类 号：R614[医药卫生—麻醉学]