右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响  

Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-αand Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting

作　　者：陈胜阳[1] 张永强[1] 刘俊[1] 刘国泽[1] 田建民[1] 岳修勤[1] CHEN Shengyang;ZHANG Yongqiang;LIU Jun;LIU Guoze;TIAN Jianmin;YUE Xiuqin(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院麻醉科,河南卫辉453100

出　　处：《新乡医学院学报》2021年第9期828-833,共6页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:2018020351)。

摘　　要：目的探讨右美托咪定(DEX)对非体外循环冠状动脉旁路移植术(OPCABG)患者血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)及克拉拉细胞蛋白16(CC16)水平的影响及DEX对肺的保护作用。方法采用随机数字表法将2016年8月至2018年9月于新乡医学院第一附属医院行OPCABG的112例冠状动脉性心脏病(CHD)患者分为观察组和对照组,每组56例。麻醉诱导前20 min,观察组患者静脉滴注DEX 1μg·kg^(-1),对照组患者静脉滴注等体积的生理盐水;第1支移植血管吻合结束后,观察组患者静脉滴注DEX 0.2~0.5μg·kg^(-1)·h^(-1)至手术结束,对照组患者静脉滴注等体积的生理盐水至手术结束。对2组患者麻醉诱导前30 min(T_(0))、气管插管后即刻(T_(1))、手术结束时(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))、术后48 h(T_(5))时的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)、呼吸指数(RI)、氧合指数(OI)及血清IL-10、TNF-α、CC16水平进行比较;术前、术后48 h采用高分辨率计算机体层摄影术(HRCT)行胸部扫描,观察肺损伤情况;观察2组患者不良反应事件及术后吗啡使用情况。结果2组患者T_(0)时MAP、HR、BIS、RI及OI比较差异无统计学意义(P>0.05);观察组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时MAP显著低于T_(0)时(P<0.05);对照组患者T_(1)、T_(4)、T_(5)时MAP显著高于T_(0)时,T_(2)、T_(3)时MAP显著低于T_(0)时(P<0.05);T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时观察组患者MAP显著低于对照组(P<0.05)。观察组患者T_(1)、T_(2)时HR显著低于T_(0)时(P<0.05),对照组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时HR显著高于T_(0)时(P<0.05);T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时观察组患者HR显著低于对照组(P<0.05)。2组患者T_(1)、T_(2)、T_(3)、T_(4)时BIS显著低于T_(0)时(P<0.05),T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时2组患者BIS比较差异无统计学意义(P>0.05)。对照组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时RI显著高于T_(0Objective To investigate the effect of dexmedetomidine(DEX)on the levels of serum interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and Clara cell protein 16(CC16)in patients undergoing off-pump coronary artery bypass grafting(OPCABG)and the protective effect of DEX on lung.Methods A total of 112 patients with coronary heart disease(CHD)who underwent OPCABG in the First Affiliated Hospital of Xinxiang Medical University from August 2016 to September 2018 were randomly divided into observation group and control group by random digits table,with 56 cases in each group.Twenty minutes before anesthesia induction,the patients in the observation group were intravenously injected with DEX 1μg·kg^(-1),and the patients in the control group were intravenously injected with equal volume of normal saline.After the anastomosis of the first graft vessel,the patients in the observation group were given DEX 0.2-0.5μg·kg^(-1)·h^(-1) by intravenous drip to the end of the operation,and the patients in the control group were given the same volume of normal saline to the end of the operation.The mean arterial pressure(MAP),heart rate(HR),bispectral index(BIS),respiratory index(RI),oxygenation index(OI)and the levels of serum IL-10,TNF-αand CC16 at 30 minutes before anesthesia induction(T_(0)),immediately after endotracheal intubation(T_(1)),the end of operation(T_(2)),and postoperative 12 hours(T_(3)),24 hours(T_(4)),48 hours(T_(5))were compared between the two groups.The lung injury was observed by high resolution computed tomography(HRCT)before operation and 48 hours after operation.The adverse reaction events and postoperative morphine using were observed in the two groups.Results There was no significant difference in the MAP,HR,BIS,RI and OI between the two groups at T_(0)(P>0.05).The MAP at T_(1),T_(2),T_(3),T_(4) and T_(5) in the observation group was significantly lower than that at T_(0)(P<0.05).The MAP at T_(1),T_(4) and T_(5) was significantly higher than that at T_(0),and the MAP at T_(2) and T_(3) was significa

关 键 词：右美托咪定 非体外循环冠状动脉旁路移植术 冠状动脉性心脏病 肺损伤 白细胞介素-10 肿瘤坏死因子-Α 克拉拉细胞蛋白16 

分 类 号：R654.3[医药卫生—外科学]