右美托咪定对烧伤脓毒症患者TNF-α、NF-κB、IL-6及血气分析指标的影响

Effect of Dexmedetomidine on TNF-α, NF-κB, IL-6 and blood gas analysis index of burn patients with sepsis

摘要:

目的研究右美托咪定对烧伤脓毒症患者肿瘤坏死因子-α（TNF-α）、核因子-κB（NF-κB）、白细胞介素6（IL-6）及血气分析指标的影响。方法选取2015 年1 月-2017 年1 月于该院选择择期手术治疗的烧伤脓毒症患者50 例。根据随机数字表分为观察组及对照组（各25 例）。所有患者均行常规麻醉诱导，观察组患者于麻醉诱导前15 min静脉输注右美托咪定0.3 μg/kg，且在手术过程中以0.3 μg/（kg·h）速率持续输注。对照组患者则给予等量生理盐水输注。分别比较不同时间两组患者的血压、心率（HR）、动脉血气分析指标水 平、静脉血TNF-α、NF-κB、IL-6水平以及住院时间、28 d病死率。结果两组患者T1、T2、T3及T4时的平均动脉压（MAP）、HR差异无统计学意义（P >0.05）。两组T1、T2、T3、T4 时的血清TNF-α、NF-κB、IL-6 水平比较，采用重复测量设计的方差分析：①不同时间TNF-α、NF-κB、IL-6水平有差异（ F=13.322、5.362和21.457，P =0.000、0.034和0.000）；②两组血清TNF-α、NF-κB、IL-6 水平有差异（F =11.472、16.813和14.195，均P=0.000），观察组血清TNF-α、NF-κB、IL-6 水平均低于对照组；③两组血清TNF-α、NF-κB、IL-6 的变化趋势有差异（F =14.623、4.974和17.765，P=0.000、0.038和0.000）。两组T1、T2、T3、T4 时的血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）/ 吸入气中的氧浓度分数（FiO2）水平比较，采用重复测量设计的方差分析：①不同时间PaO2、PaCO2/FiO2水平有差异（F =15.382和17.367，均P=0.000）；②两组的PaO2、PaCO2/FiO2水平有差异（ F=9.276和12.343，均P=0.000），观察组均高于对照组；③两组的PaO2、PaCO2/FiO2水平变化趋势有差异（F =9.156和10.485，均P=0.00）。观察组住院时间为（8.3±1.4）d，低于对照组的（9.3±1.5）d，差异有统计学意义（ <0.05）。结论右美托咪定应用于烧伤脓毒症患者手术中可有效维持术中循环稳定，具有一定的肺保护作用，有利于促进患者早日康复，值得临床推广应用。

Abstract:

Objective To explore the effect of Dexmedetomidine on TNF-α, nf-kappa B (NF-kB), IL-6 and blood gas analysis index of burn patients with sepsis. Methods A total of 50 burn patients with sepsis receiving selective operation were selected from January 2015 to March 2017. They were divided into observation group and control group according to random number table, each group included 25 cases. All the patients received general anesthesia induction, the observation group was given Dexmedetomidine 0.3 μg/kg by intravenous infusion 15 min before anesthesia induction, and 0.3 μg/(kg·h) by intravenous infusion during the operation. The control group was given normal saline at the same dosage. Blood pressure, heart rate (HR),arterial blood gas analysis index, the level of TNF-α, NF-kB and IL-6 in venous blood, hospital stay and 28-day fatality rate were compared between the two groups at different time points. Results The MAP and HR at T1, T2, T3 and T4 were no difference between two groups (P > 0.05). the levels of TNF-α, NF-kB, IL-6 at different time points were significantly different (F = 13.322, 5.362 and 21.457;P = 0.000, 0.034 and 0.000),the levels of TNF-α, NF-kB, IL-6 were different between two groups (F = 11.472, 16.813 and 14.195; allP =0.000), the levels of TNF-α, NF-kB, IL-6 observation group were lower than the control group. the change trends of TNF-α, NF-kB, IL-6 were significantly different (F = 14.623, 4.974 and 19.765;P = 0.000, 0.038and 0.000). the levels of PaO2, PaCO2/FiO2 at different time points were different (F = 15.382, 17.367; allP =0.000). The levels of PaO2, PaCO2/FiO2 were significantly different between two groups ( F= 9.276, 12.343; allP= 0.000), the observation group were higher than the control group, the change trends of PaO2, PaCO2/FiO2 levels in two groups were significantly different (F =9.156, 10.485; allP = 0.000). The hospital stay in the observation group (8.3 ±1.4) d was significantly lower than the control group (9.3 ±1.5) d (P < 0.05). Conclusions Dexmedetomidine improves the balance of hemodynamics during the operation in burn patients with sepsis, acting an effective protection to lung tissue, which is worthy of clinical popularization and application.