不同剂量右美托咪定对婴幼儿体外循环后炎性因子的影响

目的：探讨不同剂量的右美托咪定对婴幼儿先心病心内直视手术围术期炎性反应的影响。方法选择择期在体外循环下行室间隔缺损修补术的患儿60例，心功能 NYHA 分级均在Ⅰ或Ⅱ级。采用数字表法随机分为对照组（C 组），右美托咪定低剂量组（L 组），右美托咪定高剂量组（H 组），每组20例，患者入室后 L 组泵入右美托咪定0.3μg·kg -1·h -1，H 组泵入右美托咪定0.6μg·kg -1·h -1，C 组泵入等容量的0.9％氯化钠溶液至术毕。分别于麻醉诱导后（基础值，T0）、体外循环结束后10 min（T1）、体外循环结束4 h（T2）、体外循环结束24 h（T3），取静脉血标本，测量肿瘤坏死因子-α（TNF-α）和白介素-6（IL-6）浓度。结果与 T0时比较，3组 T1～ T3时血清 TNF-α和 IL-6浓度显著升高（ P ＜0.05），与 C 组比较，H 组 T1～ T3时血清 TNF-α、IL-6浓度降低（ P ＜0.05），L 组上述指标比较差异无统计学意义（ P ＞0.05）。结论术中持续输注0.6μg·kg -1·h -1的右美托咪定可明显抑制婴幼儿体外循环后炎性介质 TNF-α和 IL-6的释放。

Effects of different doses of dexmedetomidine on inflammatory factors in infants after cardiopulmonary bypass

Objective To investigate the effects of different doses of dexmedetomidine on perioperative inflammatory response of infants with congenital heart disease(CHD)undergoing intracardiac operation under direct vision. Methods Sixty infant patients with ventricular septal defect at NYHA cardiac function gradeⅠor Ⅱ grade,including 28 males and 32 females,who underwent repair of ventricular septal defect by means of cardopulmonary bypass(CPB)were enrolled in the study. The patients were randomly divided into three groups according to numeration table:control group(group C),low-dose dexmedetomidine group(group L)and high - dose dexmedetomidine group(group H),with 20 patients in each group. The patients in group L were given dexmedetomidine intravenously and infused continuously at 0. 3μg·kg - 1 ·h - 1 until end of the operation, and the patients in group H were given dexmedetomidine intravenously and infused continuously at 0. 6μg·kg - 1 ·h - 1 until end of the operation,however,the patients in group C were given equal volume of 0. 9% sodium chloride solution instead. The patients’venous blood specimens were collected after anesthesia induction,at baseline(T0), 10min after CPB(T1),4h after CPB(T2),24h after CPB(T3),then the serum levels of TNF-α and IL-6 were detected by ELISA. Results As compared with those at T0,the serum levels of TNF-α and IL-6 were significantly increased at T1 ~ T3 in the three groups( P < 0. 05). As compared with those in group C,the serum levels of TNF-α and IL-6 were significantly decreased at T1 ~ T3 in group H( P < 0. 05),but there were no significant differences in these indexes in group L( P >0. 05). Conclusion The intraoperative continuous infusion of dexmedetomidine at a rate of 0. 6μg·kg - 1 ·h - 1 can obviously inhibit the release of inflammatory mediators(TNF-αand IL-6)in infants patients after cardiopulmonary bypass.