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右美托咪定对腰椎融合术围术期炎症因子的影响
Effects of dexmedetomidine on in?ammatory responses in patients undergoing lumbar spinal fusion
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DOI:
作者:
黄小静 姚军 尚嘉伟 汪正平
HUANG Xiaojing, YAO Jun, SHANG Jiawei, WANG Zhengping
作者单位:
上海市第一人民医院麻醉科
Department of Anesthesiology, Shanghai First People’s Hospital, Shanghai Jiaotong University, Shanghai 200080, China
关键词:
右美托咪定;高迁移率族蛋白1;NF-kappa B;a2肾上腺素能受体;腰椎融合术
Dexmedetomidine; high mobility group box-1(HMGB1); NF-kappa B; a2-Adrenergic receptors; Lumbar Spinal Fusion
摘要:
【摘要】 目的 本研究观察术中应用右美托咪定对腰椎融合术围术期炎症因子的影响。方法 选择腰椎融合手术患者60例。麻醉诱导后,患者随机分为两组:处理组(右美托咪定组)给予右美托咪定0.75μg·kg-1,对照组(生理盐水组)给予生理盐水。比较两组麻醉诱导前(T0)、给予右美托咪定后(T1)、给药30min后(T2)时的术中平均动脉压(MAP)、心率(HR);比较两组术中术后麻醉镇痛药用量。于麻醉诱导前(T0)、手术结束时(T3)、术后18~20h(T4)时抽取静脉血,酶联免疫法(ELISA)测定促炎因子高迁移率族蛋白B1(HMGB1)、白介素-6(IL-6)、核因子-κB(NF-κB),抗炎因子白介素-10(IL-10)。结果 在T3、T4两个时间点上,右美托咪定组的IL-6的水平均低于生理盐水组,有统计学差异(P值均<0.05);两组之间各时间点NF-κB、HMGB1、IL-10的水平无统计学差异(P值均>0.05);与T0时间点相比较,右美托咪定组与生理盐水组的MAP、HR均有下降(P值均<0.05),但两组之间无统计学差异(P值均>0.05);两组之间麻醉性镇痛药用量无统计学差异(P值均>0.05)。结论 右美托咪定降低围术期IL-6的水平,降低手术应激,抑制围术期的炎症反应。但术前单次应用右美托咪定对术后HMGB1、NF-κB、IL-10无明显影响。
【Abstract】 Objective The aim of this study was to document the effects of dexmedetomidine on perioperative inflammatory responses. Methods Patients undergoing lumbar spinal fusion were enrolled. After induction of anaesthesia, patients in the dexmedetomidine group (n = 30, group D) received a loading dose of dexmedetomidine (0.75μg·kg-1). A saline-treated group (n = 30, group S) served as a control. Intraoperative mean arterial pressure (MAP), heart rate (HR) were compared between the groups at three times: before anaesthesia induction (T0), at the end of the administration of DEX (T1), and 30min after the administration of DEX (T2); and amount of rescue analgesic administered as post-anaesthetic care were compared between the groups. The pro-inflammatory cytokines high mobility group box 1(HMGB1), interleukin (IL)-6, and nuclear factor (NF)-kB, and anti-inflammatory cytokines IL-10 were quantified by sandwich enzyme-linked immunoassay at three times: before anaesthesia induction (T0), at the end of surgry (T3), and 18-20 hour after surgery (T4). Results At time points T3 and T4 , the IL-6 levels were lower in group D than in group S (P < 0.05). The NF-ΚB, HMGB1, and IL-10 levels were no statistically differences in two groups, as were intraoperative MAP, HR, and amount of rescue analgesic administered in and after surgery.Conclusion Dexmedetomidine administration before surgery reduced intraoperative and post-operative secretion of cytokines, and dexmedetomidine suppressed the inflammatory responses due to surgery and anaeshesia. However, dexmedetomidine single administration before surgery did not reduce post-operative secretion of HMGB1,NF-kB or IL-10 .
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