| 摘要: |
| 目的 评价右美托咪啶对体外循环患者中性粒细胞NF-κB活性的影响。方法选择期行体外循环下心脏瓣膜置换术患者40例，采用随机数字表法将患者分为右美托咪啶组（D组）及对照组（C组），每组各20例。D组麻醉诱导后给予右美托咪啶负荷量0.5μg/kg，泵注给药时间为15min，之后以维持量0.5μg/（kg·h）继续泵注维持至手术结束；C组麻醉诱导后给予等量的0.9%氯化钠溶液。记录患者主动脉阻断、体外循环及麻醉维持时间。分别于给药前（T0）、停体外循环后2h（T1）、6h（T2）及12h（T3），采集桡动脉血样行血气分析，计算呼吸指数（RI）和氧合指数（OI），提取中性粒细胞核蛋白，测定NF-κBDNA结合活性；采用ELISA法测定血浆TNF-α和IL-6水平。结果与T0比较，T1~T3时两组患者RI升高，OI降低（均P＜0.05），与C组比较，D组患者T1~T3时RI降低（均P＜0.05），但两组OI比较差异无统计学意义（P＞0.05）。与C组比较，T1~T3时点D组血浆TNF-α、IL-6水平降低；T2~T3时点中性粒细胞NF-κBDNA结合活性降低（P＜0.05）。结论右美托咪啶可抑制体外循环下换瓣患者中性粒细胞NF-κB的激活，有助于减轻体外循环炎性反应，改善患者的肺功能。 |
| 关键词: 右美托咪啶 体外循环 NF-κB 肺损伤 |
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| Effects of dexmedetomidine on NF-κB activity in patients undergoing cardiac valve replacement with cardiopulmonary bypass |
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LIAO Jianxia, CHEN Lei, WANG Liangrong, LIN Lina
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the First Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To investigate the effects of dexmedetomidine on NF-κB activity in patients undergoing valve replacement with cardiopulmonary bypass(CPB). Methods Forty ASA II or III, NYHA II or III patients undergoing cardiac valve replacement with CPB were randomly divided into dexmedetomidine group(group D, n=20) and control group (group C, n=20). After intubation, patients in group D received an initial bolus dose of dexmedetomidine (0.5μg/kg) in 15 min, immediately followed by a continuous infusion of 0.5μg/ (kg·h) until the end of the operation. The equal volume normal saline was given instead of dexmedetomidine in group C. Before administration(T0), and at 2, 6 and 12h after termination of CPB(T1~T3), blood samples were collected for determination of plasma TNF-α, IL-6 and for blood gas analysis. The nuclear protein of neutrophil granulocytes was extracted for detection of NF-κB DNA binding activity. Respiratory index (RI) and oxygenation index(OI) were calculated. Results Compared with T0, RI was increased and OI was decreased at T1~T3 (P＜0.05) in two groups. Compared with group C, RI was significantly decreased at T1~T3 in group D(P＜0.05), and no significant difference in OI was found between two groups(P ＞
0.05). Compared with group C, the plasma concentrations of TNF-α and IL-6 at T1~T3 and NF-κB DNA binding activity at T2~T3 were significantly lower (P＜0.05). Conclusion Dexmedetomidine can reduce the activity of NF-κB and it may be involved in pulmonary protection during CPB. |
| Key words: Dexmedetomidine Cardiopulmonary bypass NF-κB Lung injury |
