不同剂量的右美托咪定对全麻开胸手术患者苏醒期躁动及炎性细胞因子的影响

目的:探讨不同剂量的右美托咪定对全麻开胸手术患者苏醒期躁动及炎性细胞因子的影响。方法:80例ASAⅠ或Ⅱ级择期全麻开胸手术的患者,随机分为4组(n=20):对照组(A组)、低剂量组(B组)、中剂量组(C组)和高剂量组(D组)。B组、C组和D组麻醉诱导插管前15 min分别静脉注射右美托咪定0.25,0.5,1μg/kg,继以0.4μg/(kg·h)持续泵注至手术结束前30 min。每组缝皮开始时静注地佐辛0.1 mg/kg。A组静脉注射等容量的生理盐水。分别于麻醉诱导前(T1),术中拔除气管导管前15 min(T2)、拔除气管导管即刻(T3)、拔除气管导管后15 min(T4)各时点分别抽取5 ml静脉血,离心分离血浆。ELISA法检测血浆C反应蛋白(CRP)、炎性细胞因子TN F-α、IL-10水平。观察4组患者苏醒期躁动、镇静程度及不良反应发生情况。结果:与A组比较,T2、T3、T4时点C组、D组患者血浆CRP、血浆TNF-α水平、TNF-α/IL-10比值明显低于A组(P<0.05),血浆IL-10水平明显高于A组(P<0.05);躁动评分明显降低(P<0.05)。T2、T3、T4时点C组患者血浆CRF、血浆TNF-α水平、TN F-α/IL-10比值明显高于D组(P<0.05),血浆IL-10水平明显低于D组(P<0.05)。与A组、B组、C组比较,D组患者镇静评分明显升高,且有过度镇静和苏醒延迟的发生(P<0.05)。心动过缓、低血压的发生较多(P<0.05)。结论:右美托眯定可减少全麻开胸手术患者苏醒期躁动,其机制可能与降低血浆CRP、TNF-α水平、升高血浆IL-10水平、减少TNF-α/IL-10比值有关;中剂量组效果最好且副作用少。

Effects of Dexmedetomidine on the Emergency Agitation and Inflammatory Cytokines During Resuscitation Period in Patients Undergoing Thoracic Surgery Under General Anesthesia

Objective:To investigate the effects of dexmedetomidine(Dex) on the emergency agitation and inflammatory cytokines during resuscitation period in patients undergoing thoracic surgery under general anesthesia.Methods:Eighty ASA I or TJ patients undergoing selective thoracic surgery under general anesthesia were enrolled in this study.The patients were randomly divided into four groups(n=20):control group(group A),low dosage Dex group(group B),medium dosage group(group C),and high dosage group(group D).In groups B,C,and D,the patients received an intravenous injection of Dex(0.25,0.5,1 fig/kg) 15 minutes before intubation,and a continuous injection of Dex at a rate of 0.4μg/(kg ? h) succeeded until 30 minutes before the end of operation;while in group A,physiological saline was used instead of Dex.Venous blood was collected and separated centrifugally into blood plasma.The levels of CRP,TNF-a and IL-10 were determined before anesthesia(Tl),15 minutes before extubation during the operation (T2),at the time of extubation(T3),and 15 minutes after extubation(T4) respectively.Circumstances of emergency agitation during resuscitation period,levels of sedation,and side effects were observed.Results;Compared with group A,the levels of CRP and TNF-a and the ratio of TNF-α/IL-10 were lower(P<0.05) and the levels of IL-10 were higher(P<0.05),the agitation scores were lower(P< 0.05) in groups C and D;In group C,the levels of CRP and TNF-a and the ratio of TNF-a/IL-10 were higher than those in group D(P<0.05),and the levels of IL- 10 were lower than those in group D(P< 0.05) at the time of T2,T3 and T4.Compared with groups A,B and C,bradycardia and hypotension occurred more frequently(P<0.05).Ramsay sedation scores were higher and oversedation and delayed resuscitation were observed in group D (P<0.05).Conclusion:Dexmedetomidine can decrease emergency agitation during resuscitation period in patients undergoing thoracic surgery under general anesthesia,and the mechanism involves the inhibition of blood plasma CRP and TNF-a activation,the up-regulation of blood plasma IL-10 level and the reduction of TNF-a/IL-10 ratio.Best effects are obtained when employing medium dosage of dexmedetomidine.