中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2014年
4期
231-233
,共3页
章淬%牛永胜%王玲燕%穆心苇
章淬%牛永勝%王玲燕%穆心葦
장쉬%우영성%왕령연%목심위
主动脉夹层%右美托咪啶%炎性
主動脈夾層%右美託咪啶%炎性
주동맥협층%우미탁미정%염성
Aortic dissection%Dexmedetomidine%Inflammatory
目的 探讨右美托咪啶对主动脉夹层围手术期炎性反应的影响.方法 外科手术治疗的A型主动脉夹层患者53例,其中男40例,女13例;年龄26 ～ 75岁,平均(50.63±13.21)岁.随机分为研究组(27例)和对照组(26例):入院后及术后48 h内,研究组(A组)以右美托咪啶0.2 ～0.7μg·kg-1 ·h-1、对照组(B组)以吗啡0.2 ～0.6 mg/h维持镇痛.采集患者入院用药前(T0)、手术前(T1)、手术后(T2)、术后12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)血样,检测两组患者肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶(MMPs)、中性粒细胞弹性蛋白酶(NE)、氨基端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)值.观察两组患者在ICU期间器官功能障碍(MODS)评分及ICU停留时间.组间比较用独立样本t检验,组内比较用独立样本方差分析,P＜0.05为差异有统计学意义.结果 与B组比较,A组TNF-α水平在术后24 h显著降低(P＜0.05),MMPs水平在术后24、48、72 h显著降低(P＜0.05),NT-proBNP、NE水平在术后48、72 h显著降低(P＜0.05),CRP水平在术后48 h显著降低(P＜0.05).A组术后第5、10、15天的MODS评分较术后第1天有显著降低.结论 右美托咪啶对主动脉夹层围手术期炎性反应有抑制作用,可减少因全身过度炎性反应导致的急性脏器损伤.
目的 探討右美託咪啶對主動脈夾層圍手術期炎性反應的影響.方法 外科手術治療的A型主動脈夾層患者53例,其中男40例,女13例;年齡26 ～ 75歲,平均(50.63±13.21)歲.隨機分為研究組(27例)和對照組(26例):入院後及術後48 h內,研究組(A組)以右美託咪啶0.2 ～0.7μg·kg-1 ·h-1、對照組(B組)以嗎啡0.2 ～0.6 mg/h維持鎮痛.採集患者入院用藥前(T0)、手術前(T1)、手術後(T2)、術後12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)血樣,檢測兩組患者腫瘤壞死因子-α(TNF-α)、基質金屬蛋白酶(MMPs)、中性粒細胞彈性蛋白酶(NE)、氨基耑腦鈉肽前體(NT-proBNP)、C反應蛋白(CRP)值.觀察兩組患者在ICU期間器官功能障礙(MODS)評分及ICU停留時間.組間比較用獨立樣本t檢驗,組內比較用獨立樣本方差分析,P＜0.05為差異有統計學意義.結果 與B組比較,A組TNF-α水平在術後24 h顯著降低(P＜0.05),MMPs水平在術後24、48、72 h顯著降低(P＜0.05),NT-proBNP、NE水平在術後48、72 h顯著降低(P＜0.05),CRP水平在術後48 h顯著降低(P＜0.05).A組術後第5、10、15天的MODS評分較術後第1天有顯著降低.結論 右美託咪啶對主動脈夾層圍手術期炎性反應有抑製作用,可減少因全身過度炎性反應導緻的急性髒器損傷.
목적 탐토우미탁미정대주동맥협층위수술기염성반응적영향.방법 외과수술치료적A형주동맥협층환자53례,기중남40례,녀13례;년령26 ～ 75세,평균(50.63±13.21)세.수궤분위연구조(27례)화대조조(26례):입원후급술후48 h내,연구조(A조)이우미탁미정0.2 ～0.7μg·kg-1 ·h-1、대조조(B조)이마배0.2 ～0.6 mg/h유지진통.채집환자입원용약전(T0)、수술전(T1)、수술후(T2)、술후12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)혈양,검측량조환자종류배사인자-α(TNF-α)、기질금속단백매(MMPs)、중성립세포탄성단백매(NE)、안기단뇌납태전체(NT-proBNP)、C반응단백(CRP)치.관찰량조환자재ICU기간기관공능장애(MODS)평분급ICU정류시간.조간비교용독립양본t검험,조내비교용독립양본방차분석,P＜0.05위차이유통계학의의.결과 여B조비교,A조TNF-α수평재술후24 h현저강저(P＜0.05),MMPs수평재술후24、48、72 h현저강저(P＜0.05),NT-proBNP、NE수평재술후48、72 h현저강저(P＜0.05),CRP수평재술후48 h현저강저(P＜0.05).A조술후제5、10、15천적MODS평분교술후제1천유현저강저.결론 우미탁미정대주동맥협층위수술기염성반응유억제작용,가감소인전신과도염성반응도치적급성장기손상.
Objective To investigate the effects of dexmedetomidine on the inflammatory response during the aortic dissection perioperative period.Methods 53 patients with the type A aortic dissection who needed surgical treatment were randomly divided into the study group and the control group.Patients in the study group (group A) received dexmedetomidine (0.2-0.7 μg · kg-1 · h-1) while patients in the control group (group B) received morphine 0.2-0.6 mg/h to ease pain after they were admitted and continued to 48 h after the operation.The serum levels of TNF-α,MMPs,NE,NT-proBNP and CRP were measured in the patients at the time enrolled taking none of the two drugs(T0),before the operation(T1),immediately after the operation (T2) and 12 h (T3),24 h (T4),48 h (T5),72 h (T6) after the operation.MODS score and the length of stay in ICU were observed about the two groups of patients.Difference between the two groups was determined by the Student' s t-test.Single factor analysis of variance was used within the group.P ＜ 0.05 was considered statistically significant.Results Compared with the patients in group B,the MMPs levels in group A at 24、48 and 72 h after the operation were significantly lower.The patients in group A had lower levels of NT-proBNP and NE both at 48 h and 72 h after the operation.Lower levels of TNF-α and CRP were also found at 24 h and 48 h in this group.The MODS score at the fifth 、tenth and 15th day after the surgery were both significantly lower than that of the first day in patients of group A.Conclusion Dexmedetomidine can inhibit the inflammatory response during the aortic dissection perioperative period and can reduce the acute injury of organs caused by the excessive systemic inflammatory response.
