右美托咪定对体外循环围术期外周血单核细胞HMGB-1表达及肾功能相关指标的影响

目的探讨右美托咪定对体外循环心内直视手术围术期外周血单核细胞HMGB．1表达及血BUN、血Cr、尿NAG／Cr比值、尿B2微球蛋白／Cr比值的影响。方法选取择期行体外循环瓣膜置换术患者60例，随机分为生理盐水对照组（30例）和右美托咪定组（DEX组）（30例），分别于麻醉诱导前30min给予生理盐水、0．6μg／（kgxh）右美托咪定至手术结束。分别于T1（麻醉诱导前）、T2（体外循环结束时）、T3（术后6h）、T4（术后24h）、T5（术后48h）5时点取血分离单核细胞，免疫印迹法检测HMGB-1的表达水平，并分别检测血BUN、血Cr、尿NAG／Cr比值、尿B2微球蛋白／Cr比值。结果对照组和DEX组外周血单核细胞的HMGB-1在麻醉开始前（T1）就有表达，转流结束时（T2）继续升高，术后6h（T3）达到高峰，术后24h（T4）略有降低，并于术后第2天（T5）继续升高；DEX组与对照组相比，除T1时间点外，T2～T5四个时间点的HMGB-1表达量均显著低于对照组（P〈0．05）。DEX组和对照组的血BUN、血Cr、尿132．MG／Cr在T1时间点上均无明显差异。而血BUN、血Cr、尿β2-MG／Cr在T2～T5四个时间点上DEX组均明显低于对照组（P〈0．05），但两组尿NAG／Cr在T1、T3两个时间点上均无明显差异，而在T2、T4和T5三个时间点上DEX组均明显低于对照组（P〈0．05）。结论右美托咪定可以显著降低体外循环期间外周血单核细胞HMGB-1的表达，且能明显降低不同时间点。肾功能相关指标，提示其可能具有-定的肾保护效应。

The effect of Dexmedetomidine on HMGB-1 expression in peripheral blood mononuclear cells and repal function indicators during the cardiopulmonary bypass

Objective To observe the effect of Dexmedetomidine on HMGB-1 expression in peripheral blood mononuclear cells, serum concentration of Bun and Cr, and the ratio of urinary NAG/Cr, 132-MG/Cr during the cardiopulmonary bypass （CPB）. Methods 60 cases of ASA grade II-IV undergoing cardiac valve replacement under CPB, were randomly chosen for this trial. Patients were randomly given normal saline （NS group） or Dexmedetomidine （Dex group） during 30 min before induction until the end of operation. Blood samples were taken and urine was collected before induction （TI）, after CPB （T2）, 6 （T3）, 24 （T4） and 48 （TS） hours after operation. The HMGB-1 expression level in peripheral blood mononuclear cells was determined by western blotting. Serum urea nitrogen （BUN）, serum creatinine （Cr）, urinary NAG, urinary 132- microglobulin （132-MG） and urinary creatinine （UCr） were also analyzed. Results The HMGB-1 of peripheral blood mononuclear cells was expressed before the induction （T1）, and the HMGB-1 expression level increased at the end of CPB （T2） and reached the peak at 6 hours after operation （T3）. The HMGB-1 expression level was then decreased at 24 hours after operation （T4） and increased at 48 hours after operation （TS）. The HMGB-1 expression level of Dex group was significantly decreased at time points T2-T5 （P〈0.05）. The Dex group＇s concentration of serum BUN, serum Cr, urinary NAG/Cr and urinary 132-MG/Cr were also significantly decreased at time points T2-T5 compared with NS group （P〈0.05）. Conclusion Dexmedetomidine can suppress HMGB-1 expression in peripheral blood mononuclear cells during CPB, and can decrease the level of renal function＇s indicators, suggesting that it may have a renal protective effect, and suppress HMGB-1 expression during CPB.