右美托咪定程序化镇静对机械通气急性肾损伤患者免疫和肾脏功能的影响

摘要

Objective To investigate the effects of immunity and renal function for AKI patients undergoing mechanical ventilation using dexmedetomidine proceduralized sedation protocol. Methods 60 AKI patients undergoing mechanical venti-lation in the ICU were randomly divided into dexmedetomidine group (group A),propofol group (group B),midazolam group (group C),20 cases in each group. Three groups were all implemented procedural sedation program,included analgesia,seda-tion,evaluation,daily interruption of sedation. The blood samples of the patients were taken immediately before sedation (T0),the first day after sedation (T1),the second day after sedation (T2),for determing the level of TNF-α,IL-6,SOD,Scr,BUN,CysC. Results Compared with T0 time point,the levels of serum TNF-α and IL-6 of the patients in groups A,B,C at T1 time point slightly increased,and serum SOD decreased. Compared with T1 time point,the levels of serum TNF-α and IL-6 decreased,and serum SOD had not significant change. However,by comparing the data between intra-group and inter-group, there was no sig-nificant difference at all time points (P>0.05). Within the data of intra-group,compared with T0 time point,the levels of serum Scr in group A significantly decreased at T2 time point (P<0.05). But group B and group C had no significant difference at all time points (P>0.05). Within the data of inter-group,compared with group C,the level of serum Scr in group A significantly de-creased at T1 and T2 time point(P<0.05),the level of serum CysC in group A also significantly decreased at T2 time point(P<0.05), but had no significant difference at all time points compared with group B (P>0.05). Conclusion Compared with mi-dazolam,using dexmedetomidine proceduralized sedation protocol can effectively decrease the levels of serum Scr and CysC for AKI patients undergoing mechanical ventilation, it maybe have protective effect on renal function,and have no effect on immune function.%目的：探讨右美托咪定程序化镇静对机械通气急性肾损伤（AKI）患者免疫和肾脏功能的影响。方法选择ICU使用机械通气的AKI患者60例，随机分为右美托咪定组（A组）、丙泊酚组（B组）、咪达唑仑组（C组），各20例。3组患者入组后均开始实施程序化镇静方案，包括镇痛、镇静、评估、每日中断镇静4个部分，并于镇静前（T0）、镇静后第1天（T1）、镇静后第2天（T2）晨抽取静脉血，测定血清TNF-α、IL-6、SOD、Scr、BUN、CysC水平。结果与T0相比，A、B、C 3组T1时间点TNF-α和IL-6有所升高，SOD降低；T2较T1 TNF-α和IL-6水平有所降低，SOD无明显变化，通过组内和组间比较差异均无统计学意义（P>0.05）。在组内比较中，与T0相比，A组T2时间点Scr明显降低，差异有统计学意义（P＜0.05），B组和C组差异均无统计学意义（P>0.05）。在组间比较中，与C组相比，A组T1时间段Scr和T2时间段Scr、CysC水平均有明显降低，差异有统计学意义（P＜0.05），与B组比较差异无统计学意义（P>0.05）。结论右美托咪定相对于咪达唑仑在程序化镇静时可降低机械通气AKI患者的Scr、CysC水平，可能对肾脏功能有保护作用，对免疫功能无明显影响。