右美托咪定联合曲马多通过影响IL-10、CRP、p38 MAPK在妊娠期高血压疾病治疗的研究  

The effect of dexmedetomidine combined with tramadol on IL-10,CRP and p38 MAPK in the treat-ment of pregnancy-induced hypertension

作　　者：许城城 罗茜华 赵辉 张秋珍[1,2] 郑丹玲 赵承宽 张夏兰 张述耀[1] 林朝仙 XU Chengcheng;LUO Qianhua;ZHAO Hui;ZHANG Qiuzhen;ZHENG Danling;ZHAO Chengkuan;ZHANG Xialan;ZHANG Shuyao;LIN Chaoxian(Guangzhou Red Cross Hospital,Jinan University,Guangzhou 510220,China;Shantou University Medical College,Shantou 515041,China;The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Shantou Chaonan Minsheng Hospital,Shantou 515144,China)

机构地区：[1]暨南大学附属广州红十字会医院,广东广州510220 [2]汕头大学医学院药理学教研室,广东汕头515041 [3]汕头大学医学院第二附属医院,广东汕头515041 [4]汕头潮南民生医院,广东汕头515144

出　　处：《现代医院》2022年第7期1135-1140,1145,共7页Modern Hospitals

基　　金：2020年广东省科技专项资金(“大专项+任务清单”)项目(200113165875501);汕头市科技计划医疗卫生类别项目(汕府科{2017}182号)。

摘　　要：目的探讨妊娠期高血压疾病(PIH)患者剖宫产后采用右美托咪定(DXM)联合曲马多(TMD)以PCIA模式治疗对IL-10、CRP、p38 MAPK的影响以及与镇痛、镇静效果的关联。方法将356例PIH患者随机分为DXM组、TMD组和DXM+TMD组,再将各组分别按不同剂量分为3组。检测手术前后不同时间点各组患者血浆IL-10、CRP和血清p-p38 MAPK水平,并评估疼痛评分与镇静程度,比较不同时段对MAP、HR、RR、SpO2影响情况,统计恶心呕吐、呼吸抑制等不良反应发生率。结果与其他亚组相比,DXM+TMD 2、3组的IL-10水平手术后24 h与48 h出现明显升高(P<0.05),CRP与p-p38 MAPK水平则显著降低(P<0.05),降低MAP、HR更显著(P<0.05),不影响RR与SpO2(P>0.05),镇痛与镇静评分更满意(P<0.05)。各亚组均出现不良反应,但不影响继续治疗。结论DXM联合TMD通过增加IL-10水平,抑制CRP水平和p38 MAPK活化而发挥抑制炎症效应,有效地降低PIH患者剖宫产后的高血压,并发挥良好的镇痛、镇静作用。Objective To investigate the effect of dexmedetomidine(DXM)combined with tramadol(TMD)with PCIA on IL-10,CRP,p38 MAPK and the association with analgesia and sedation in patients with pregnancy-induced hypertension(PIH)after cesarean delivery.Methods A total of 356 patients with pregnancy-induced hypertension were randomly divided into DXM,TMD and DXM+TMD groups,each of which was further divided into 3 groups according to different doses.And then,plasma IL-10,CRP and serum p-p38 MAPK levels were detected at different time points before and after operation in each group,and the pain scores and sedation degree were evaluated.The effects of different periods on MAP,HR,RR and SpO2 were compared,and the incidence of adverse reactions such as nausea,vomiting and respiratory depression were counted.Results Compared with other subgroups,in the DXM+TMD 2 and 3 groups,IL-10 levels were significantly higher,CRP and p-p38 MAPK levels were significantly lower at 24h and 48h after surgery(P<0.05),the effects on reducing MAP,HR were more significant(P<0.05),with no effect on RR and SpO2(P>0.05),and analgesia and sedation scores were more satisfactory(P<0.05).Adverse effects were observed in all groups in the study but did not affect the continuation of treatment.Conclusion DXM combined with TMD exerts an inhibitory effect on inflammation by increasing IL-10 levels,inhibiting CRP levels and p38 MAPK activation,effectively reducing hypertension in PIH patients after cesarean delivery while exerting a good analgesic and sedative effect.

关 键 词：妊娠期高血压疾病 右美托咪定 曲马多 P38丝裂原活化蛋白激酶 白介素10 C反应蛋白 

分 类 号：R969.4[医药卫生—药理学]