右美托咪定对心脏瓣膜置换术患者外周血单核细胞焦亡的影响  

Effects of dexmedetomidine on monocyte pyroptosis in peripheral blood of patients with cardiac valve replacement

作　　者：杨丽娟 刘秀叶 商玉茹 何云锋 王莉[1] Yang Lijuan;Liu Xiuye;Shang Yuru;He Yunfeng;Wang Li(Department of Anesthesiology,the First Hospital of Hebei Medical University,Shijiazhaung 050035,China)

机构地区：[1]河北医科大学第一医院麻醉科,石家庄050035

出　　处：《中华麻醉学杂志》2021年第10期1193-1197,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价右美托咪定对心脏瓣膜置换术患者外周血单核细胞焦亡的影响。方法择期心脏瓣膜置换术患者44例,性别不限,年龄45~64岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=22):右美托咪定组(Dex组)和生理盐水组(NS组)。Dex组于常规麻醉诱导后经10 min静脉输注右美托咪定0.5μg/kg,继之以0.5μg·kg-1·h-1的速率输注至术毕;NS组以等容量生理盐水替代。于麻醉诱导后切皮前(T1)、CPB开始后30 min(T2)、CPB停止即刻(T3)及停止后24 h(T4)时采集颈内静脉血样,采用ELISA法测定血浆IL-18和IL-1β浓度,采用Western blot法检测单核细胞NOD样受体蛋白结构域相关蛋白3(NLRP3)、含半胱氨酸的天冬氨酸蛋白水解酶-1(caspase-1)及消皮素-D(GSDMD)的表达。记录术中丙泊酚、舒芬太尼、去甲肾上腺素的用量、术后机械通气时间及ICU停留时间。结果与T1时比较,2组T2~4时血浆IL-18和IL-1β浓度升高,单核细胞NLRP3、caspase-1和GSDMD表达上调(P<0.05);与NS组比较,Dex组T2~4时血浆IL-18和IL-1β浓度降低,单核细胞NLRP3、caspase-1和GSDMD表达下调,术后机械通气时间缩短(P<0.05),术中丙泊酚、舒芬太尼、去甲肾上腺素的用量和ICU停留时间差异均无统计学意义(P>0.05)。结论右美托咪定减轻心脏瓣膜置换术患者炎症反应的机制可能与抑制NLRP3/caspase-1通路,减轻外周血单核细胞焦亡有关。Objective To investigate the effects of dexmedetomidine on monocyte pyroptosis in peripheral blood of patients with cardiac valve replacement.Methods Forty-four American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes,aged 45-64 yr,with body mass index of 18-25 kg/m^(2),of New York Heart AssociationⅡorⅢ,scheduled for elective cardiac valve replacement,were divided into 2 groups(n=22 each)using a random number table method:dexmedetomidine group(group Dex)and normal saline group(group NS).In group Dex,dexmedetomidine was intravenously infused in a dose of 0.5μg/kg over 10 min starting from the end of anesthesia induction,followed by a continuous infusion at 0.5μg·kg-1·h-1 until the end of operation,while the equal volume of normal saline was given instead of dexmedetomidine in group NS.Before skin incision(T1),at 30 min after the beginning of cardiopulmonary bypass(CPB)(T2),immediately after the end of CPB(T3)and at 24 h after CPB(T4),the blood samples of internal jugular vein were collected for determination of the concentrations of plasma interleukin-18(IL-18)and IL-1β(by enzyme-linked immunosorbent assay),and the expression of NOD-like receptor family,pyrin domain containing 3(NLRP3),caspase-1 and gasdermin-D(GSDMD)in monocytes(by Western blot).The intraoperative consumption of propofol,sufentanil and norepinephrine,time of postoperative mechanical ventilation and time of intensive care unit stay were recorded.Results The levels of plasma IL-18 and IL-1βand expression of NLRP3,caspase-1 and GSDMD in monocytes were significantly higher at T2-4 than at T1 in two groups(P<0.05).Compared with group NS,the levels of plasma IL-18 and IL-1βwere significantly decreased and the expression of NLRP3,caspase-1 and GSDMD was down-regulated at T2-4,postoperative mechanical ventilation time was shortened(P<0.05),and no significant change was found in the consumption of propofol,sufentanil and norepinephrine and time of intensive care unit stay in group Dex(P>0.05).Conclusion The mechanism

关 键 词：右美托咪啶 心肺转流术 炎症 细胞焦亡 

分 类 号：R614[医药卫生—麻醉学]