右旋美托咪啶镇静治疗对严重创伤后炎症因子的影响

 目的：探讨右旋美托咪啶（DEX）在严重创伤患者短期镇静治疗中对严重创伤后炎症因子的影响。方法：随机将60例入住重症监护病房（ICU）的严重创伤患者分为3组：DEX镇静组（DEX组，n=20）、咪达唑仑（MDZ）镇静组（MDZ组，n=20）和不用镇静剂的对照组（n=20）。DEX组：先静脉注射DEX负荷量1~2 μg/kg（>10 min），继以微量注射泵持续静脉泵注维持量0.2~0.7 μg·kg^-1·h^-1。MDZ组：先静脉注射MDZ负荷量0.03~0.3 mg/kg，继以微量注射泵持续静脉泵注维持量0.03~0.2 mg·kg^-1·h^-1。镇静2组均以Ramsay氏镇静评分分级Ⅱ~Ⅳ级为镇静目标，根据Ramsay评分调整用量，实施2 d的短程镇静治疗。分别检测患者在入院时、24 h和48 h血清中白细胞介素1（IL-1)、IL-6、肿瘤坏死因子α（TNF-α）和C反应蛋白（CRP）水平。结果：3组患者TNF-α、IL-1、IL-6和CRP水平在入住ICU时均明显高于正常值，3组差异无统计学意义（P>0.05）；对照组TNF-α、IL-1、IL-6和CRP在24 h和48 h逐步升高，而DEX组和MDZ组的上述指标有所下降，分别与对照组比较差异有统计学意义（P<0.05）；DEX组和MDZ组TNF-α、IL-1、IL-6和CRP水平在24 h无显著差异（P>0.05），但在48 h差异显著（P<0.05）。结论：右旋美托咪啶可在一定程度上降低创伤后过度应激反应，阻止炎症介质的进一步产生和释放，有助于严重创伤患者的稳定和恢复。

Effect of sedation by infusion of dexmedetomidine on inflammatory factors in patients with severe trauma

AIM: To study the effect of short-term sedation by infusion of dexmedetomidine (DEX) on the inflammatory factors in the patients with severe trauma. METHODS: Sixty patients with severe trauma in ICU were randomly divided into 3 groups: DEX group (n=20), midazolam (MDZ) group (n=20) and control group (without any sedatives, n=20). Dexmedetomidine at an initial loading dose of 1~2 μg/kg was administered intravenously over 10 min to the patients in DEX group before the sedation procedure of continuous infusion at dose of 0.2~0.7 μg·kg^-1·h^-1 by a 50-mL infusion syringe was perform. Midazolam at dose of 0.03~0.3 mg/kg was also administered intravenously immediately before the procedure of a continuous infusion at dose of 0.03~0.2 mg·kg^-1·h^-1. The doses of DEX or MDZ for the patients receiving short-term (48 h) sedation were adjusted according to the Ramsay sedation scale scores. The serum levels of interleukins (IL-1 and IL-6), tumor necrosis factor α (TNF-α) and C-reactive protein (CRP) were measured at the time points of the baseline (before the start of the study), 24 h and 48 h of sedative infusion. RESULTS: The levels of TNF-α, IL-1, IL-6 and CRP in the 3 groups of severe traumatic patients at the time when they were admitted to the hospital were significantly higher than those of the normal values. The levels of TNF-α, IL-1, IL-6 and CRP in control group gradually increased at 24 h and 48 h, while those in DEX group and MDZ group significantly declined. No significant difference of TNF-α, IL-1, IL-6 and CRP levels between DEX group and MDZ group was observed at 24 h, but the changes were significantly different at 48 h. CONCLUSION: Dexmedetomidine reduces over-stress responses to a certain extent in the traumatic patients to prevent the further production and release of inflammatory mediators, thus contributing to the stability and recovery of the patients with severe trauma.