CAJ | 학술논문

目的评价不同剂量右美托咪定对体外循环(CPB)下心内直视手术患儿肺损伤的影响.方法择期CPB下行室间隔缺损修补术患儿48例,年龄7个月～3岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患儿分为4组(n=12):对照组(C组)和不同剂量右美托咪定组(D1-3组).D1-3组给予初始剂量0.5 μg/kg的右美托咪定(给药时间＞10 min),继之分别以0.1、0.3、0.5 μg·kg-1 ·h-1的速率维持直至术毕,C组给予等容量生理盐水.分别于给药前(T1)、停CPB后2、6和12 h(T2-4)时采集桡动脉血样,测定血浆TNF-α、IL-6和IL-8的浓度,并进行血气分析,计算呼吸指数(RI)、氧合指数(OI)和肺顺应性(CL).结果与C组比较,D2.3组T2-4时血浆TNF-α和IL-8浓度降低,T3-4时血浆IL-6浓度降低(P＜0.05);与D1组比较,D2.3组T2-4时血浆TNF-α、IL-8浓度及RI降低,OI及CL升高,D2组T3,4时及D3组T2-4时血浆IL-6浓度降低(P＜0.05);与D2组比较,D3组T2.3时血浆TNF-α和IL-6浓度降低,OI及CL升高,T2-4时血浆IL-8浓度及RI降低(P＜0.05).结论右美托咪定可减轻CPB下心内直视手术患儿的肺损伤,改善术后肺功能,其机制可能与抑制CPB诱发炎症反应有关,并呈剂量依赖性.
목적 평개불동제량우미탁미정대체외순배(CPB)하심내직시수술환인폐손상적영향.방법 택기CPB하행실간격결손수보술환인48례,년령7개월～3세,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장환인분위4조(n=12):대조조(C조)화불동제량우미탁미정조(D1-3조).D1-3조급여초시제량0.5 μg/kg적우미탁미정(급약시간＞10 min),계지분별이0.1、0.3、0.5 μg·kg-1 ·h-1적속솔유지직지술필,C조급여등용량생리염수.분별우급약전(T1)、정CPB후2、6화12 h(T2-4)시채집뇨동맥혈양,측정혈장TNF-α、IL-6화IL-8적농도,병진행혈기분석,계산호흡지수(RI)、양합지수(OI)화폐순응성(CL).결과 여C조비교,D2.3조T2-4시혈장TNF-α화IL-8농도강저,T3-4시혈장IL-6농도강저(P＜0.05);여D1조비교,D2.3조T2-4시혈장TNF-α、IL-8농도급RI강저,OI급CL승고,D2조T3,4시급D3조T2-4시혈장IL-6농도강저(P＜0.05);여D2조비교,D3조T2.3시혈장TNF-α화IL-6농도강저,OI급CL승고,T2-4시혈장IL-8농도급RI강저(P＜0.05).결론 우미탁미정가감경CPB하심내직시수술환인적폐손상,개선술후폐공능,기궤제가능여억제CPB유발염증반응유관,병정제량의뢰성.
Objective To evaluate the effects of different doses of dexmedetomidine on lung injury in pediatric patients undergoing open heart surgery under cardiopulmonary bypass (CPB).Methods Forty-eight pediatric patients,aged 7 months-3 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective repair of ventricular septal defect under CPB,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).Anesthesia was induced with midazolam,fentanyl and vecuronium.The patients were endotracheally intubated and mechanically ventilated.In D1-3 groups,dexmedetomidine 0.5μg/kg (initial dose) was given over more than 10 min,followed by continuous infusion at 0.1,0.3 and 0.5 μg· kg-1 · h-1,respectively,until the end of operation.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration (T1),and at 2,6 and 12 h after termination of CPB (T2-4),blood samples were collected for determination of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and IL-8 concentrations and for blood gas analysis.Respiratory index (RI),oxygenation index (OI) and lung compliance (CL) were calculated.Results The plasma concentrations of TNF-α and IL-8 at T2-4 and IL-6 at T3,4 were significantly lower in D2,3 groups than in group C.Compared with group D1,the plasma concentrations of TNF-α,IL-8 and RI were significantly decreased,and OI and CL were increased at T2-4 in D2-3 groups,and the plasma IL-6 concentrations at T3,4 in group D2 and at T2-4 in group D3 were decreased.The plasma concentrations of TNF-α and IL-6 were significantly lower,while OI and CL were higher at T2,3,and the plasma concentrations of IL-8 and RI were lower at T2-4 in group D3 than in group D2.Conclusion Dexmedetomidine can reduce lung injury in pediatric patients undergoing open heart surgery under CPB and promote the lung function after CPB possibly through inhibiting inflammatory responses to CPB dosedependently.