右美托咪啶对脂多糖诱导大鼠外周血单核细胞Toll样受体4mRNA表达的影响

目的 探讨右美托咪啶对脂多糖(LPS)诱导大鼠外周血单核细胞Toll样受体4(TLR4)mRNA表达的影响.方法 健康雄性Wistar大鼠40只,取外周血分离培养单核细胞,采用随机数字表法,将其随机分为5组(n=8),A组:阴性对照;B组:单核细胞中加入LPS(终浓度为1μg/ml);C组:单核细胞中加入LPS(终浓度为1μg/ml)+右美托咪啶(终浓度为0.5 ng/ml);D组:单核细胞中加入LPS(终浓度为1μg/ml)+右美托咪啶(终浓度为5.0 ng/ml);E组:单核细胞中加入LPS(终浓度为1μg/ml)+右美托咪啶(终浓度为50.0 ng/ml).孵育24 h后,收集上清液,采用ELISA法测定TNF-α、IL-1β和IL-6的浓度,采用RT-PCR法测定TLR4 mRNA的表达.结果 与A组比较,B组TNF-α、IL-1p、IL-6的浓度升高,TLR4 mRNA表达上调(P＜0.01);与B组比较,C组、D组和E组TNF-α、IL-1β、IL-6的浓度降低,TLR4 mRNA表达下调(P＜0.05或0.01);与C组比较,D组和E组TNF-α、IL-1β、IL-6的浓度降低(P＜0.01),TLR4 mRNA表达差异无统计学意义(P＞0.05);D组和E组各指标比较差异无统计学意义(P＞0.05).结论 右美托咪啶可通过下调TLR4 mRNA表达,抑制TLR4的合成,从而抑制LPS诱导大鼠外周血单核细胞TNF-α、IL-1β和IL-6的生成与释放.

Abstract：

Objective To investigate the effects of different concentrations of dexmedetomidine on the expression of Toll-like receptor 4 (TLR4) mRNA in rat peripheral blood monocytes exposed to lipopolysaccharide ( LPS ). Methods Peripheral blood monocytes isolated from male Wistar rats were seeded in 24-well plate in RPMI 1640 liquid culture medium in CO2 incubator at 37 ℃ and 5% CO2 for 2 h, and were randomly divided into 5 groups ( n = 8 each): group A negative control; group B was exposed to LPS 1 μg/ml and C, D and E groups were exposed to LPS 1 μg/ml + dexmetomidine 0.5, 5.0 and 50.0 ng/ml respectively. The monocytes were then incubated for 24 h. The concentrations of TNF-α, IL-1β and IL-6 in the supernatant of the cultured monocytes were detected by ELISA. The expression of TLR4 mRNA in the monocytes was detected by RT-PCR.Results Exposure to LPS significantly increased the expression of TLR4 mRNA and the concentrations of TNF-α, IL-1β and IL -6 in group B as compared with group A ( P ＜ 0.01 ). Dexmedetomidine attenuated the LPS-induced increase in the expression of TLR 4 mRNA and the concentrations of TNF-α, IL-1β and IL-6 in a dose-dependent manner ( P ＜0.05or 0.01 ). Conclusion Dexmedetomidine can inhibit the synthesis of TLR4 and inhibit the secretion and dilivery of TNF-α, IL-1β and IL-6 by down-regulating the gene expression of TLR4 in rat peripheral blood monocytes exposed to LPS.     

右美托咪定对神经病理性痛大鼠脊髓Toll样受体4和NF-κB表达的影响

目的 评价右美托咪定对神经病理性痛大鼠脊髓Toll样受体4和NF-κB表达的影响.方法 健康成年雄性Wistar大鼠108只,6～8周龄,体重180 ～ 220 g,采用随机数字表法,将其分为3组(n=36):假手术组(S组)、神经病理性痛组(NP组)和右美托咪定组(D组).采用坐骨神经慢性压榨性损伤法制备神经病理性痛模型,D组于术后即刻开始至处死前1d腹腔注射右美托咪定50μg/kg,1次/d.S组和NP组以等容量生理盐水替代.于术前1d,术后3、7、14 d时测定机械痛阈和热痛阈,并于术后测定痛阈后处死,取L4-6脊髓组织,采用RT-PCR法测定TLR4 mRNA和NF-κB mRNA的表达,采用免疫组织化学法测定脊髓背角TLR4和NF-κB的表达水平.结果 与S组比较,NP组和D组机械痛阈和热痛阈降低,TLR4及其mRNA、NF-κB及其mRNA的表达上调(P＜0.05);与NP组比较,D组机械痛阈和热痛阈升高,TLR4及其mRNA、NF-κB及其mRNA的表达下调(P＜0.05).结论 右美托咪定减轻大鼠神经病理性痛的机制与抑制TLR4和NF-κB表达有关.     

右美托咪啶对老年人术后认知功能的影响

目的:探讨右美托咪啶对老年人术后认知功能的影响及可能作用机制.方法:将择期手术治疗的腰椎骨折和髋关节置换术46例患者随机分为对照组(I组)和右美托咪啶组(II组),II组麻醉诱导前静脉输注右美托咪啶,负荷剂量0.8 ug/kg,输注时间10~15 min,以0.5 mg·kg-1·h-1的速率持续至术毕,I组给予等容量的生理盐水.于给药前(T1)、手术开始后1 h(T2)和手术结束后(T3)检测血浆皮质醇浓度,分别于术前1 d、术后1 d、术后3 d、术后7 d评估病人认知功能状态.结果:与I组比较,II组术后认知功能障碍发生率明显降低(P<0.05),皮质醇浓度在麻醉诱导后(T2)明显降低(P<0.05).结论:右美托咪啶围术期给药,可预防老年人认知功能障碍发生,其可能机制与降低皮质醇浓度有关.     

肝移植术病人围术期中性粒细胞Toll样受体2表达与术后SIRS的关系

目的 研究肝移植术病人围术期中性粒细胞Toll样受体2(TLR2)表达与术后全身炎性反应综合征(SIRS)的关系.方法 择期行肝移植术的终末期肝病病人20例,年龄33～58岁,体重52～73 kg,心功能Ⅱ或Ⅲ级,ASAⅢ或Ⅳ级.于麻醉诱导前(T1)、无肝期25 min(T2)、新肝期3 h(T3)、新肝期24 h(T4)时,中心静脉采血样,采用流式细胞仪测定中性粒细胞TLR2表达;ELISA法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-8(IL-8)浓度;按术后7 d内是否发生SIRS,分为SIRS组与非SIRS组.2组TNF-α、IL-1β和IL-8浓度和TLR2表达进行Spearman相关分析.结果 术后7 d内有10例病人发生SIRS.与T1时比较,SIRS组T4时中性粒细胞TLR2表达上调,T2-4时TNF-α浓度升高,T3,4时IL-1β浓度升高,T3时IL-8浓度升高(P＜0.05或0.01);与NSIRS组比较,SIRS组T4时中性粒细胞表达上调,血清IL-1β浓度升高,T3时血清IL-8浓度升高(P＜0.05或0.01).SIRS组TNF-α浓度与中性粒细胞TLR2表达呈正相关(r=0.607,P＜0.05).结论 肝移植术后病人发生SIRS可能与新肝期24 h中性粒细胞TLR2表达上调有关.     

右美托咪啶对老年人术后认知功能的影响

目的:探讨右美托咪啶对老年人术后认知功能的影响及可能作用机制。方法:将择期手术治疗的腰椎骨折和髋关节置换术46例患者随机分为对照组(I组)和右美托咪啶组(II组),II组麻醉诱导前静脉输注右美托咪啶,负荷剂量0.8 ug/kg,输注时间10～15 min,以0.5 mg.kg-1.h-1的速率持续至术毕,I组给予等容量的生理盐水。于给药前(T1)、手术开始后1 h(T2)和手术结束后(T3)检测血浆皮质醇浓度,分别于术前1 d、术后1 d、术后3 d、术后7 d评估病人认知功能状态。结果:与I组比较,II组术后认知功能障碍发生率明显降低(P<0.05),皮质醇浓度在麻醉诱导后(T2)明显降低(P<0.05)。结论:右美托咪啶围术期给药,可预防老年人认知功能障碍发生,其可能机制与降低皮质醇浓度有关。     

右美托咪啶对老年患者腹腔镜下宫颈癌根治术后早期认知功能的影响

目的 评价右美托咪啶对老年患者腹腔镜下宫颈癌根治术后早期认知功能的影响.方法 择期腹腔镜下宫颈癌根治术患者60例,ASA分级Ⅰ或Ⅱ级,年龄65～80岁,体重55～74 kg,采用随机数字表法,将其随机分为2组(n=30):生理盐水组(NS组)和右美托咪啶组(DEX组).麻醉诱导后DEX组静脉输注右美托咪啶0.2,μg·kg-1·h-1,NS组给予等容量生理盐水,术毕静脉注射芬太尼0.5 μg/kg,并停止给予麻醉药物.分别于术前1d和术后7d对患者进行认知功能测验.结果 DEX组术后7d时认知功能障碍发生率低于NS组(P＜0.05).结论 右美托咪啶可降低老年患者腹腔镜下宫颈痛根治术后早期认知功能障碍的发生.     

不同剂量右美托咪啶对单肺通气患者围术期炎性反应的影响

目的 探讨不同剂量右美托咪啶对单肺通气患者围术期炎性反应的影响.方法 择期行食管癌根治术患者36例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄43～72岁,体重50～78 kg,采用随机数字表法,将其随机分为3组(n=12):对照组(C组)、低剂量右美托咪啶组(D1组)和高剂量右美托咪啶组(D2组).麻醉诱导前,D1组和D2组经10 min静脉输注右美托咪啶1 μg/kg,随后分别以0.2和0.5 μg·kg-1 ·h-1的速率输注至术毕前30 min,C组采用同样方法静脉输注等容量生理盐水.于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气30 min(T2)、90 min(T3)、膨肺后30 min(T4)和术后2 h(T5)时采集静脉血样,测定血清TNF-α、IL-8浓度.结果 与T0时比较,三组T3～T5时血清TNF-α、IL-8浓度升高(P＜0.05);与C组比较,D2组T3～T5时血清TNF-α、IL-8浓度降低(P＜0.05),D1组上述指标差异无统计学意义(P＞0.05).结论 麻醉诱导前给予右美托咪啶1 μg/kg,术中以0.5 μg·kg-1·h-1的速率输注可明显降低单肺通气患者围术期的炎性反应.     

异丙酚对LPS诱导中性粒细胞Toll样受体2和Toll样受体4表达的影响

目的 探讨异丙酚对内毒素(LPS)诱导中性粒细胞Toll样受体2(TLR2)和TLR4表达的影响.方法 健康志愿者6名,年龄20～35岁,各采集外周静脉血样50 ml,加入20 U/ml肝素抗凝,分离提纯中性粒细胞,制备细胞悬液,然后随机分为6组,每组6皿:对照组(C组)不给予任何药物,置于37℃、5%CO_2培养箱中培养12 h;异丙酚脂质溶剂intralipid组(I组)、异丙酚组(P组)和LPS组(L组):分别加入intralipid(终浓度为5 μg/ml)、异丙酚(终浓度为5 μg/ml)或LPS(终浓度为1μg/ml),置于37℃、5%CO_2培养箱中孵育12 h;intralipid+LPS组(IL组)和异丙酚+LPS组(PL组)先分别加入intralipid(终浓度为5 μg/ml)或异丙酚(终浓度为5 μg/ml)后,置于37℃、5%CO_2培养箱中孵育20 min,然后加入LPS(终浓度为1μg/ml),置于37℃、5%CO_2培养箱孵育12 h.采用流式细胞仪测定中性粒细胞膜TLR2和TLR4的表达;采用荧光定量PGR检测中性粒细胞膜TLR2 mRNA和TLR4 mRNA的表达;采用ELISA法测定培养上清液TNF-α和IL-8的浓度.结果 与C组比较,I组和P组TLB2和TLR4的表达、1NF-α和IL-8L-8的浓度差异无统计学意义(P>0.05),L组和IL组TLR2和TLR4的表达上调,L组TNF-α和IL-8L-8的浓度升高,IL组IL-8浓度升高(P<0.05);与L组比较,IL组TLR2和TLR4的表达、TNF-α和IL-8L-8的浓度差异无统计学意义(P>0.05),PL组TLR2和TLR4的表达下调,TNF-α和IL-8L-8的浓度降低(P<0.05).各组TLR2 mRNA和TLR4 mRNA的表达差异无统计学意义(P>0.05).结论 异丙酚可下调LPS诱导的中性粒细胞TLR2和TLR4的表达,从而抑制炎性反应.     

右美托咪啶辅助静吸复合全麻用于小儿气管异物取出术的效果

目的 评价右美托咪啶辅助静吸复合全麻用于小儿气管异物取出术的效果.方法 拟行气管异物取出术患儿60例,性别不限,年龄1～4岁,体重8 ～ 23 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患儿随机分为静吸复合全麻组(Ⅰ组)和右美托咪啶辅助静吸复合全麻组(Ⅱ组),每组30例.入室后面罩吸入8％七氟醚诱导入睡,入睡后减至4％,Ⅱ组静脉输注右美托咪啶0.5 μg/kg,随后静脉注射异丙酚2 mg/kg,接着静脉输注异丙酚6mg·kg-1·h-1和瑞芬太尼0.15 μg·kg-·min-1维持麻醉,Ⅰ组除不用右美托咪啶外余同Ⅱ组,2 min后停止吸入七氟醚开始置入硬支气管镜.于进镜前、进镜1和5 min时记录HR和SpO2,记录呼吸抑制、喉头水肿和心动过缓等的发生情况,术后记录异丙酚和瑞芬太尼总用量、镜检满意情况及苏醒时间.结果 与Ⅰ组比较,Ⅱ组患儿进镜1和5 min时HR降低,进镜1 min时SpO2升高,异丙酚和瑞芬太尼用量减少,手术时间缩短,苏醒时间延长,镜检满意度升高,呼吸抑制和喉头水肿发生率降低(P＜0.05).结论 右美托咪啶辅助静吸复合全麻用于小儿气管异物取出术的效果较静吸复合全麻好,且并发症少.     

右旋美托咪啶对老年患者行经尿道前列腺电切除术后认知功能障碍的影响

目的探讨右旋美托咪啶对老年患者经尿道前列腺电切除术后认知功能障碍的影响。方法选择全身麻醉下择期行经尿道前列腺电切除术后,美国麻醉医师协会(ASA)分级I~II级的老年患者80例,年龄65~85岁,采用随机数字表法随机分为右旋美托咪啶组(40例)和对照组(40例)。右旋美托咪啶组在全麻插管后给予右美托咪定负荷剂量0.5μg·kg-1,输注时间10 min,然后以维持剂量0.5μg·kg-1·h-1持续泵注,手术结束前40 min停止输注;对照组以相同方法静脉给予等容量0.9%氯化钠注射液。两组患者于麻醉前和术后第4 d和7 d应用简易智力状态量表(MMSE)评估术后认知功能。结果两组患者术前MMSE评分无差异;右旋美托咪啶术后第4 d和7 d MMSE评分明显高于对照组(P0.05)。结论应用右旋美托咪啶能提高老年患者经尿道前列腺电切除术后认知功能。     

不同速率输注右美托咪定对老年白内障手术患者的镇静效应

目的 观察不同速率输注右美托咪定对老年白内障手术患者球后神经阻滞麻醉下的镇静效应.方法 选择90例60～80岁白内障手术患者,根据应用右美托咪定维持剂量随机均分为右美托咪定Ⅰ组(0.2μg·kg-1·h-1)、Ⅱ组(0.4μg·kg-1·h-1)、Ⅲ组(0.6 μg·kg-1 ·h-1).观察并记录三组患者麻醉前(T0)、神经阻滞完毕即刻(T1)、用药后10 min(T2)、20 min(T3)、30 min(T4)、60 min(T5)的Ramsay评分和MAP、HR、RR、SpO2.结果 T2～T5时各组Ramsay评分高于T0时(P＜0.05),T3～T5时Ⅲ组高于Ⅰ组(P＜0.05).T3～T5时三组HR显著慢于T0时(P＜0.05),以Ⅲ组减慢最明显;T3～T5时三组RR均慢于T0时,但差异无统计学意义;三组间MAP、SpO2差异无统计学意义.结论 静注右美托咪定0.5 μg/kg后以0.2～0.4 μg·kg- 1·h-1维持适合老年白内障手术患者的清醒镇静.     

右美托咪定对腹腔镜前列腺癌根治术老年患者局部脑氧饱和度和术后认知功能的影响

目的观察右美托咪定对腹腔镜前列腺癌根治术老年患者对局部脑氧饱和度(rSO_2)和术后认知功能的影响。方法选择择期行腹腔镜前列腺癌根治手术的老年患者60例,年龄65~80岁,ASA分级Ⅰ~Ⅲ级,随机均分为两组:右美托咪定组(D组)在全麻诱导插管后泵注右美托咪定0.5μg/kg,10min泵注完毕,然后以0.5μg·kg~(-1)·h~(-1)的速度持续泵注至手术结束前30min,对照组(C组)泵入等量的生理盐水。术中使用FORE-SIGHT_脑氧饱和度监测仪监测rSO_2。记录入室时(T_0)、诱导插管后(T_1)、气腹后60min(T_2)和苏醒后(T_3)的rSO_2、MAP、PaCO_2和PaO_2。记录丙泊酚和瑞芬太尼的使用情况、术后躁动和恶心呕吐的发生情况。于术前1d、术后1d和3d使用蒙特利尔认知功能评分量表(MoCA)进行评分,记录患者术后认知功能障碍(POCD)发生情况。结果T_2时两组rSO_2、PaCO_2明显高于T_1时(P0.05)。D组患者丙泊酚和瑞芬太尼用量明显少于C组(P0.05)。D组MoCA评分明显高于C组(P0.05);D组2例(6.7%)患者发生POCD,明显低于C组的9例(30%)(P0.05)。结论右美托咪定用于老年患者腹腔镜前列腺癌根治手术对rSO_2未见明显影响,但可以减少POCD的发生。     

右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛的效果

目的 评价右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛(PCIA)的效果.方法 择期脊椎-硬膜外麻醉下行剖宫产术病人120例,年龄18～40岁,身高155～170 cm,采用随机数字表法,将病人随机分为3组(n=40):Ⅰ组于胎儿娩出后静脉注射生理盐水20 ml,术后采用舒芬太尼进行PCIA(背景输注速率0.015μg·kg-1·h-1,PCA量0.023 μg/kg,锁定时间8 min);Ⅱ组于胎儿娩出后静脉注射右美托咪啶0.5 μg/kg,术后PCIA同Ⅰ组;Ⅲ组术中处理同Ⅱ组,术后采用舒芬太尼混合右美托咪啶进行PCIA(舒芬太尼背景输注速率0.015 μg·kg-1·h-1,右美托咪啶背景输注速率0.045 μg·kg-1·h-1,舒芬太尼PCA量0.023 μg/kg、右美托咪啶PCA量0.07 μg/kg,锁定时间8 min).于麻醉前和输注右美托咪啶1 h时测定痛阈和耐痛阈,于术后4、8、24 h时记录VAS评分、警觉/镇静评分和舒芬太尼用量,于术后3 h时记录恶露排出量,记录泌乳发动时间,于术后24 h时行病人满意度评价,于麻醉前和输注右美托咪啶1 h、术后24 h时采集外周静脉血样,采用双抗体夹心酶联免疫吸附法测定血清皮质醇浓度,记录不良反应的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组输注右美托眯啶1 h时痛阈和耐痛阈升高,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,病人满意度升高(P＜0.05);与Ⅱ组比较,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,Ⅲ组病人满意度升高(P＜0.05);其余指标组间比较差异无统计学意义(P＞0.05).结论 右美托咪啶混合舒芬太尼用于剖宫产术后PCIA的效果优于单独应用舒芬太尼.

Abstract：

Objective To evaluate the efficacy of dexmedetomidine combined with sufentanil for patientcontrolled intravenous analgesia (PCIA) after caeserean section. Methods One hundred and twenty parturients aged 18-40 yr undergoing caeserean section under spinal-epidural anesthesia were randomly assigned to one of 3 groups( n=40 each):group Ⅰ , group Ⅱ and group Ⅲ . During operation as soon as the baby was bom a bolus of dexmedetomidine 0.5 μg/kg was given iv in Ⅱ and Ⅲ groups while in group Ⅰ normal saline (NS) was given instead. Ⅰ and Ⅱ groups received PCIA with sufentanil (background infusion 0.015 μg·kg-1·h-1;bolus dose 0.023 μg/kg;lockout interval 8 min). Group Ⅲ received PCIA with sufentanil + dexmedetomidine (background infusion sufentanil 0.015 μg·kg-1 ·h-1 + dexmedetomidine 0.045 μg·kg· h-1;bolus dose sufentanil 0.023 μg/kg + dexmedetomidine 0.07 μg/kg;lockout interval 8 min) . Pain threshold and pain tolerance threshold were measured before caeserean section and 1 h after bolus dose of dexmedetomidine or NS. VAS, OAA/S and satisfaction scores and sufentanil consumption were recorded at 4, 8 and 24 h after operation.Blood samples were obtained before anesthesia,1 h after bolus injection of dexmedetomidine, and 24 h after operation for determination of serumcortisol concentration. Results Pain threshold and pain tolerance threshold at 1 h after bolus injection of dexmedetomidine were significantly increased as compared with the baseline before anesthesia in Ⅱ and Ⅲ groups and were significantly higher in Ⅱ and Ⅲ groups than in group Ⅰ . VAS scores and the consumption of sufentanil were significantly lower while the satisfactory score was significantly higher in group Ⅲ than in Ⅰ and Ⅱ groups. Serum cortisol concentrations were significantly increased at 1 h after iv dexmedetomidine or NS injection as compared with the baseline before anesthesia in all 3 groups, but there was no significant difference in serum cortisol levels among the 3 groups. Conclusion Addition of dexmedetomidine to sufentanil for PCIA can significantly reduce the consumption of sufentanil and improve parturient's satisfaction.     

右美托咪啶对非体外循环冠状动脉旁路移植术患者心肌损伤的影响

目的 评价右美托咪啶对非体外循环冠状动脉旁路移植术患者心肌损伤的影响.方法 择期非体外循环冠状动脉旁路移植术患者46例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄37～64岁,采用随机数字表法,将其随机分为2组(n=23),两组麻醉诱导及麻醉维持方法相同.右美托眯啶组(D组)于麻醉诱导后持续静脉输注右美托咪啶0.5 μg·kg-1∶h-1至术毕,对照组(C组)给予等容量生理盐水.分别于手术开始、血管吻合完毕、血管吻合完毕后30 min和术毕时记录平均肺动脉压、肺毛细血管楔压;中心静脉压和心输出量,计算每搏指数、左室每搏功指数、右室每搏功指数、周围血管阻力和肺血管阻力.分别于麻醉诱导前、术毕、术后4 h和术后24 h时采集静脉血样,采用ELISA法测定血浆心肌肌钙蛋白Ⅰ浓度.结果 与C组比较,D组术毕时每搏指数和左室每搏功指数升高,血管吻合完毕后30 min和术毕时周围血管阻力降低,术后24 h时血浆cTnI浓度降低(P＜0.05);其余血液动力学指标组间差异无统计学意义(P＞0.05).结论 术中静脉输注右美托咪啶0.5 μg·kg-1·h-1可减轻非体外循环冠状动脉旁路移植术患者心肌损伤.

Abstract：

Objective To evaluate the cardioprotective effect of dexmedetomidine in patients undergoing off-pump coronary artery bypass grafting. Methods Forty-six ASA Ⅱ or Ⅲ patients aged 37-64 yr weighing 54-81 kg undergoing off-pump coronary artery bypass grafting were randomized into 2 groups ( n = 23 each): control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine was infused at 0.5 μg·kg-1·h-1 starting after induction of anesthesia until the end of operation in group D. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein. HR, MAP, mean pulmonary arterial pressure, pulmonary capilary wedge pressure, central venous pressure, and cardiac output were recorded and stroke volume index, left and right ventricular stroke work index, systemic vascular resistance and pulmonary vascular resistance were calculated at the beginning of operation (T1 ), immediately (T2 ) and at 30 min after reestablishment of coronary blood flow (T3 ) and the end of operation (T4 ) . Venous blood samples were taken before induction of anesthesia (T0 , baseline) , at T4 and 4 h (T5 ) and 24 h (T6 ) after operation for determination of plasma concentration of cardiac troponin I by ELISA. Results Stroke volume index and left ventricular stroke work index were significantly higher at T4 while systemic vascular resistance was lower at T34 in group D than in group C. Plasma cardiac troponin Ⅰ concentration was significantly lower at T6 in group D than in group C. Conclusion Dexmedetomidine infusion at 0.5 μg ·kg-1·h-1 during operation can protect myocardium in patients undergoing off-pump coronary artery bypass grafting.     

右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应

目的 评价右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应.方法 选择行上腹部手术的冠心病患者80例,性别不限,年龄43～76岁,体重52～80 kg,ASA分级Ⅱ或Ⅲ级,NYHA 分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组(n=40):对照组(C组)和右美托咪啶组(D组).D组麻醉诱导前10 min静脉注射右美托咪啶负荷剂量1μg/kg,继之以0.4μg·kg-1·h-1的速率维持至术毕,C组给予等容量生理盐水.两组术中维持BIS值40～49.于麻醉诱导前和术毕时取血样,测定血清IL-6、TNF-α、cTnI和糖原磷酸化酶BB(GP-BB)的浓度,记录术中心血管不良反应的发生情况.结果 与C组比较,D组血清IL-6、,TNF-α、cTnI及GP-BB水平明显降低,心动过缓发生率升高,心动过速和心肌缺血发生率降低(P<0.05).结论 右美托咪啶对冠心病患者非心脏手术期间可产生心肌保护效应,其机制可能与抑制促炎性细胞因子释放有关.

Abstract：

Objective To evaluate the myocardial protective effect of dexmedetomidine during non-cardiac surgery in patients with coronary heart disease.Methods Eighty ASAⅡor Ⅲ patients with coronary heat disease (NYHA Ⅱ or Ⅲ)aged 43-76 yr weighing 52-80 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups(n=40 each)：control group(group C)and dexmedetomidine group(group D).Anesthesia was induced with etomidate 0.25 mg／kg,sufentanil 0.5 μg／kg and vecuronium 0.1 mg／kg.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1μg/kg was injected intravenously 10 min before induction followed by infusion at 0.4 μg·kg-1·h-1 until the end of operation in group D.While equal volume of normal saline was given in group C.BIS was maintained at 40-49.Blood samples were taken before induction and at the end of operation for determination of serum concenlrations of IL-6,TNF-α,cardiac troponin Ⅰ(cTnI)and glycogen phosphorylase BB(GP-BB).The adverse cardiovascular events were recorded during operation.Results The serum concentrations of IL-6,TNF-α,cTnI and GP-BB and incidences of tachycardia and myocardial ischemia were significantly lower,while the incidences of bradycardia highcr in group D than in group C (P<0.05).Conclusion Dexmedetomidine Can exert the myocardial protective effect during non-cardiac surgery in patients with coronary heart disease and the mechanism may be related to the inhibition of the release of pro-inflammatory cytokines.     

右美托咪定复合小剂量氯胺酮在困难气道纤维支气管镜插管中镇静遗忘的效果

目的观察右美托咪定复合小剂量氯胺酮在择期手术困难气道患者纤维支气管镜经鼻气管插管中的镇静遗忘的效果。方法择期困难气道纤维支气管镜经鼻插管患者90例,ASAⅠ或Ⅱ级,按照随机数字表法均分为三组:右美托咪定1.0μg/kg+氯胺酮0.5 mg·kg-1·h-1(DK组)、右美托咪定1.0μg/kg+丙泊酚2.0mg·kg-1·h-1(DP组)和右美托咪定1.0μg/kg+瑞芬太尼5.0μg·kg-1·h-1(DR组)。比较三组患者入室后安静10min(T0)、纤维支气管镜置入前(T1)、气管导管进入声门即刻(T2)及插管后5min(T3)时HR、MAP、SpO2及Ramsay镇静评分和不良反应,及术后24h随访患者对气管插管过程的知晓情况。结果与T0时比较,T1时DP和DR组HR明显减慢,MAP明显下降,T1时DP组SpO2明显降低(P0.05);T3时DP和DR组HR明显加快,DR组MAP明显增高(P0.05);T2时DR组MAP明显高于DP组。T2时DP组和DR组Ramsay镇静评分明显低于DK组,T3时DR组Ramsay镇静评分明显低于DK和DP组(P0.05);DP组心动过缓、呼吸抑制发生率明显高于DK组,DR组呛咳、躁动、心动过速、插管知晓发生率明显高于DK组(P0.05)。结论右美托咪定复合小剂量氯胺酮用于困难气道患者经鼻纤支镜插管可保证良好的镇静遗忘效果,维持稳定的血流动力学,并且不良反应发生率低。     

右美托咪啶与咪达唑仑复合舒芬太尼用于肝癌微波治疗术患者麻醉效果的比较

目的 比较右美托咪啶与咪达唑仑复合舒芬太尼用于肝癌微波治疗术患者麻醉的效果.方法 择期行经皮肝穿刺微波治疗术的肝癌患者40例,男性,ASA分级Ⅱ级,年龄35～62岁,体重45～70 kg,采用随机数字表法,将其随机分为2组(n=20):咪达唑仑组(Ⅰ组)和右美托咪啶组(Ⅱ组).Ⅰ组静脉注射咪达唑仑负荷量40μg/kg,然后静脉输注咪达唑仑40μg·kg-1·h-1;Ⅱ组静脉注射右美托眯啶负荷量1μg/kg,然后静脉输注右美托咪啶0.5μg·kg-1·h-1.两组药物负荷量均用生理盐水稀释至20ml,注射时间均为10 min.负荷量注射完毕后5 min时,静脉注射舒芬太尼负荷量0.2μg/kg,然后采用舒芬太尼行PCIA,背景输注速率0.1μg·kg-1·h-1,PCA量0.1μg/kg,锁定时间3 min.舒芬太尼负荷量注射完毕后2 min开始手术.记录术中心动过缓、心动过速、低血压、高血压和呼吸抑制的发生情况;记录舒芬太尼的PCA总按压次数和有效按压次数.结果 两组心动过缓、心动过速、低血压和高血压的发生率比较差异无统计学意义(P＞0.05);与Ⅰ组比较,Ⅱ组呼吸抑制发生率降低,舒芬太尼PCA总按压次数和有效按压次数减少(P＜0.05).结论 肝癌微波治疗术患者右美托咪啶复合舒芬太尼的麻醉效果优于咪达唑仑复合舒芬太尼.

Abstract：

Objective To compare the efficacy of anesthesia with dexmedetomidinc and midazolam combined with sufentanil in patients undergoing microwave coagulation therapy for liver cancer. Methods Forty ASA Ⅱ male patients, aged 35-62 yr, weighing 45-70 kg, scheduled for percutaneous microwave coagulation therapy,were randomly divided into 2 groups ( n = 20 each): midasolam group ( group Ⅰ ) and dexmedetomidine group ( group Ⅱ ). A loading dose of midazolam 40 μg/kg ( in normal saline 20 ml) was given intravenously over 10 min,followed by midasolam infusion at 40 μg·kg-1 ·h-1 in group Ⅰ . A loading dose of dexmedetomidine 1 μg/kg (in normal saline 20 ml ) was given intravenously over 10 min, followed by dexmedetomidine infusion at 0.5 loading dose of sufentanil 0.2 μg/kg was given, and then patient-controlled intravenous anesthesia with sufentsnil (background infusion 0.1 μg·kg-1 ·h-1 , bolus dose 0.1 μg/kg, lockout interval 3 min) was used. The operation was started 2 min after administration of the loading dose of sufentanil. Bradycardia, tachycardia, hypotension, hypertensinn and respiratory depression were recorded. The number of attempts and successfully delivered doses was also recorded. Results There was no significant difference in the incidence of bradycardia, tachycardia, hypotension and hypertension between the two groups ( P ＞ 0 .05). The incidence of respiratory depression was significantly lower, and the number of attempts and successfully delivered doses was smaller in group Ⅱ than in group Ⅰ ( P ＜ 0.05). Conclusion The efficacy of anesthesia with dexmedetomidine and sufentanil is better than that of anesthesia with midazolam and sufentanil in patients undergoing microwave coagulation therapy for liver cancer.     

右美托咪定对单肺通气患者血浆IL-8、IL-10及肺组织AQP1表达的影响

目的评价右美托咪定对单肺通气(one lung ventilation,OLV)患者血浆IL-8、IL-10及肺组织水通道蛋白(aquaporin,AQP)1表达的影响。方法择期行肺癌根治术患者40例,男23例,女17例,年龄40~75岁,ASAⅠ或Ⅱ级,采用随机数字表法将患者均分为两组:对照组(C组)和右美托咪定组(D组)。麻醉诱导前10 min,D组静注右美托咪定1μg/kg,随后以0.5μg·kg-1·h-1的速率输注至手术结束前30min,C组采用同样的方法静注等容量的生理盐水。于OLV前即刻(T1)、OLV 30min(T2)、60min(T3)、120min(T4)、恢复双肺通气后30min(T5)、术后2h(T6)取桡动脉血,测定血浆IL-8和IL-10的浓度。于OLV前即刻、肺叶离体时取肺组织,测定AQP1的表达。结果 T3~T6时C组及T3~T5时D组IL-8浓度,T2~T5时两组IL-10浓度明显高于T1时(P0.05);D组T3~T6时IL-8浓度明显低于,T2~T5时IL-10浓度明显高于C组(P0.05)。C组肺叶离体时AQP1表达明显低于OLV前即刻和D组(P0.05)。结论给予负荷量1μg/kg的右美托咪定,随后以0.5μg·kg-1·h-1的速率持续输注,可以降低单肺通气患者全身炎症反应,上调肺组织AQP1表达。     

乌司他丁联合右美托咪定对老年食管癌患者术后认知功能的影响

目的 观察乌司他丁联合右美托咪定(dexmedetomidine,Dex)麻醉对老年食管癌患者术后早期认知功能的影响. 方法 拟行择期手术的老年食管癌患者60例,年龄65～84岁,ASA分级Ⅰ～Ⅲ级.采用随机数字表法将患者分为干预组(Ⅰ组)和对照组(Ⅱ组),每组30例.气管插管后,Ⅰ组乌司他丁2×105 U,溶于100 ml生理盐水,30 min内静脉滴注,Dex 0.5 μg·kg-1·h-1泵注至手术结束前0.5 h;Ⅱ组静脉滴注等容量的生理盐水.分别在术前1d和术后1、3d对患者进行神经心理学测试,计算术后成绩与术前基础值的差值(X值),记录术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生情况.分别于麻醉诱导前(T0)、术毕时(T1)、术后1 d(T2)及术后3 d(T3)抽取外周动脉血,ELISA法分别检测S-100β蛋白、神经元特异性烯醇化酶(neuron-specific enolase,NSE)及IL-6浓度. 结果 X值比较:与Ⅱ组比较,Ⅰ组数字符号测试、累加测试及循迹连线测试A均显著降低(P＜0.05).Ⅰ组和Ⅱ组POCD发生率分别为6.7％和30.0％,Ⅰ组显著低于Ⅱ组(P＜0.05).T1时点,Ⅰ组S-100β蛋白、NSE及IL-6浓度均显著低于Ⅱ组(P＜0.05);T2时点,Ⅰ组NSE及IL-6浓度均显著低于Ⅱ组(P＜0.05);T3时点,Ⅰ组IL-6浓度显著低于Ⅱ组(P＜0.05). 结论 乌司他丁联合Dex麻醉可以降低老年食管癌患者早期POCD的发生率,可能与其降低血清S-100β蛋白、NSE及IL-6浓度有关.