右美托咪定对ARDS机械通气患者炎症因子及肺损伤的影响

目的观察右美托咪定对急性呼吸窘迫综合症(ARDS)机械通气患者炎症因子及肺损伤的影响。方法选择40例ARDS机械通气患者,根据患者使用和未使用右美托咪定,将患者分成右美托咪定组(右美托咪定组,n=20)和对照组(n=20)。前者静脉泵注右美托咪定负荷量1μg/kg 15 min,再以0.2~0.7μg/kg·h速率持续输注48 h;对照组患者静脉泵注丙泊酚3~5 mg/(kg·h)为48 h,两组均复合舒芬太尼0.1~0.2μg/(kg·h)。分别于插管前(T0)、插管后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)各时间点抽取静脉血检测IL-6、IL-8、IL-10的浓度,同时记录Pa O2/Fi O2。结果与T0时比较,T1~T4时两组的IL-6、IL-8、IL-10的浓度显著升高(P0.05),D组Pa O2/Fi O2T2~T4时显著增高(P0.05)、C组T1~T4时显著降低(P0.05),HR在T1~T4时D组降低,C组增高(P0.05)。与C组比较,T2~T4时D组IL-6、IL-8显著降低、IL-10显著升高(P0.05);T2~T4时Pa O2/Fi O2升高(P0.05);T1~T4时D组HR降低,T2~T4时MAP升高(P0.05)。结论右美托咪定用于ARDS机械通气治疗患者,可以平衡炎症因子的释放,有利于减轻肺损伤。

Effects of dexmedetomidine on inflammation factors and lung injury in ARDS patients during ventilation

［Abstract］ Objective To analyze the effects of dexmedetomidine on inflammation factors and lung injury in ARDS patients during ventilation. Methods This article consisted of forty patients with acute respiratory distress syndrome（ARDS）who had been hospitalized in our hospital from. The patients were divided into two groups according to using dexmedetomidin（dexmedetomidine group, n=20）or without using dexmedetomidine （control group, n=20）. The patients of dexmedetomidine group received the management of intravenously infused with dexmedetomidine 1 μg/kg to 15 min, and followed by 0.2?0.7 μg（/kg·h）. Propofol was given intravenously the ratio of 3?5 mg（/kg·h） until 48 h later in control group. All patients were administrated with sufentanil 0.1?0.2 μg（/kg·h）in both groups. Blood was draw from vein to detect IL?6, IL?8, IL?10, and PaO2/FiO2 was recorded respectively at pre?intubation（T0）, 6 h（T1）, 12 h（T2）, 24 h（T3）and 48 h after intubation（T4）. Results Compared with T0 , the levels of IL?6, IL?8 and IL?10 were higher at T1 ?T4 in two groups（P<0.05）. PaO2/FiO2 was higher at T2 ?T4 in dexmedetomidine group and were lower at T1 ?T4 than in control group（P<0.05）. HR were higher at T1 ?T4 in dexmedetomidine group and lower in control group （P<0.05）. Compared with control group, the patients in dexmedetomidine group showed lower levels of IL?6, IL?8 and higher levels of IL?10 and PaO2/ FiO2 at T2?T4 （P<0.05）. Conclusion Administration of dexmedetomidine for the ARDS patients with mechanical ventilation reduces the release of inflammatory factors and may reduce lung injury.