右旋美托咪啶用于鼻内镜手术控制性降压时对炎症因子的影响

摘要

目的：观测右旋美托咪啶用于鼻内镜手术时进行控制性低血压时对炎症因子的影响。方法：选取在全身麻醉下实施鼻内镜术患者80例，ASA分级Ⅰ~Ⅱ级，用随机数字表法将患者分成生理盐水空白组(C组)和右旋美托咪定组(D组)，每组40例。麻醉诱导开始前(T1)30 min， D组静脉持续缓慢输注右旋美托咪定负荷剂量1.0μg/kg，然后持续以0.5μg/kg·h的速率静脉输注维持至手术结束，C组静脉注射等容量生理盐水。分别记录麻醉诱导前30 min(T0)、气管插管时刻(T1)、气管导管拔出时刻(T2)的MAP(平均动脉压)、HR(心率)，抽取T0、T2、术后2 h(T3)、术后6 h(T4)、手术结束后12 h(T5)、手术结束后24 h(T6)的外周静脉血用来检测C反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)在血液中的浓度。结果：T1、T2时间点为手术过程当中刺激最大的时间点，C组T1、T2时间点较T0时HR、MAP明显升高，比较差异均有统计学意义(P<0.05)。D组T0、T1、T2时间点HR变化不明显，MAP有所升高，比较差异均有统计学意义(P<0.05)。D组T1、T2时间点HR、MAP较C组明显降低，比较差异均有统计学意义(P<0.05)。C组中CRP从T3时间点开始升高，IL-6，TNF-α均从T2时间点开始升高，在T4时点升至最高点，T5时点开始下降，与本组T0时间点比较差异均有统计学意义(P<0.05)。D组CRP从T4时间点开始升高，IL-6、TNF-α均从T3时间点开始升高，在T4时间点升至最高点，T5时点开始下降，与本组T0时间点比较差异均有统计学意义(P<0.05)。D组在T2~6各时间点的CRP、IL-6和TNF-α水平均明显低于C组，两组比较差异均有统计学意义(P<0.05)。结论：右旋美托咪定在鼻内镜手术时用于控制性降压是安全有效的，而且可以降低炎症反应，降低术后感染的几率。%Objective:To investigate the effects of deliberate hypotension of dexmedetomidine on inflammatory factors in patients undergoing endoscopic sinus surgery.Method:Eighty ASA Ⅰor Ⅱpatients scheduled for elective endoscopic sinus surgery were randomly divided into blank group(group C) and dexmedetomidine group(group D),each group of 40 cases.Group D was given continual intravenous injection of dexmedetomidine(1.0μg/kg) at 30 minutes before induction of anesthesia,followed by infusion of dexmedetomidine[0.5μg/(kg·h)] until the end of surgery.Group C was given an equal volume of normal saline. Heart rate(HR),mean arterial pressure(MAP) were determined 30 minutes before anesthesia induction(T0),immediately after induction(T1),immediately after extubation(T2).The cervical venous blood samples were obtained from the patient at 30 minutes before anesthesia induction (T0),when endotracheal tube was removed (T2) and 2 h(T3),6 h(T4),12 h(T5),24 h(T6) post operation for determination of the expression of CPR,IL-6 and TNF-α.Result:The difference of the general situation and the monitoring indicators of intraoperative between the patients of the two groups was not statistically significant(P>0.05).Compared with group C,CPR,IL-6 and TNF-αof group D were all lower at each time point of T2-T6,difference was statistically significant (P<0.05).Compared with T0,CPR of group C was began to rise from T3,IL-6 and TNF-αof group C were began to rise from T2,and rosen to the highest at T4,began to decline at T5;CPR of group D was began to rise from T4,IL-6 and TNF-αof D group were began to rise from T3,and rosen to the highest at T4,began to decline at T5,difference was statistically significant (P<0.05).Conclusion:Deliberate hypotension of dexmedetomidine in patients undergoing endoscopic sinus surgery is safe and feasible and can reduce inflammation and postoperative infection.