[1]陈胜阳,张永强,刘　俊,等.右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响[J].新乡医学院学报,2021,38(9):828-833.[doi:10.7683/xxyxyxb.2021.09.006]
　CHEN Shengyang,ZHANG Yongqiang,LIU Jun,et al.Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting[J].Journal of Xinxiang Medical University,2021,38(9):828-833.[doi:10.7683/xxyxyxb.2021.09.006]
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右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年9
页码:
828-833
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting
作者:
陈胜阳; 张永强; 刘　俊; 刘国泽; 田建民; 岳修勤
（新乡医学院第一附属医院麻醉科，河南　卫辉　453100）
Author(s):
CHEN Shengyang; ZHANG Yongqiang; LIU Jun; LIU Guoze; TIAN Jianmin; YUE Xiuqin
(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
右美托咪定; 非体外循环冠状动脉旁路移植术; 冠状动脉性心脏病; 肺损伤; 白细胞介素-10; 肿瘤坏死因子-α; 克拉拉细胞蛋白16
Keywords:
dexmedetomidine off-pump coronary artery bypass grafting coronary heart disease lung injury interleukin-10 tumor necrosis factor-α Clara cell protein 16
分类号:
R654.3
DOI:
10.7683/xxyxyxb.2021.09.006
文献标志码:
A
摘要:
目的　探讨右美托咪定（DEX）对非体外循环冠状动脉旁路移植术（OPCABG）患者血清白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）及克拉拉细胞蛋白16（CC16）水平的影响及DEX对肺的保护作用。方法　采用随机数字表法将2016年8月至2018年9月于新乡医学院第一附属医院行OPCABG的112例冠状动脉性心脏病（CHD）患者分为观察组和对照组，每组56例。麻醉诱导前20 min，观察组患者静脉滴注DEX 1 μg·kg-1，对照组患者静脉滴注等体积的生理盐水；第1支移植血管吻合结束后，观察组患者静脉滴注DEX 0.2～0.5 μg·kg-1·h-1至手术结束，对照组患者静脉滴注等体积的生理盐水至手术结束。对2组患者麻醉诱导前30 min（T0）、气管插管后即刻（T1）、手术结束时（T2）、术后12 h（T3）、术后24 h（T4）、术后48 h（T5）时的平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）、呼吸指数（RI）、氧合指数（OI）及血清IL-10、TNF-α、CC16水平进行比较；术前、术后48 h采用高分辨率计算机体层摄影术（HRCT）行胸部扫描，观察肺损伤情况；观察2组患者不良反应事件及术后吗啡使用情况。结果　2组患者T0时MAP、HR、BIS、RI及OI比较差异无统计学意义（P＞0.05）；观察组患者T1、T2、T3、T4、T5时MAP显著低于T0时（P<0.05）；对照组患者T1、T4、T5时MAP显著高于T0时，T2、T3时MAP显著低于T0时（P<0.05）；T1、T2、T3、T4、T5时观察组患者MAP显著低于对照组（P<0.05）。观察组患者T1、T2时HR显著低于T0时（P<0.05），对照组患者T1、T2、T3、T4、T5时HR显著高于T0时（P<0.05）；T1、T2、T3、T4、T5时观察组患者HR显著低于对照组（P<0.05）。2组患者T1、T2、T3、T4时BIS显著低于T0时（P<0.05），T1、T2、T3、T4、T5时2组患者BIS比较差异无统计学意义（P＞0.05）。对照组患者T1、T2、T3、T4、T5时RI显著高于T0时（P<0.05），观察组患者T1、T2、T3、T4时RI显著高于T0时（P<0.05）。T1、T2、T3、T4、T5时观察组患者RI显著低于对照组（P<0.05）。对照组患者T2、T3、T4、T5时OI显著低于T0时（P<0.05），观察组患者T2、T3、T4时OI显著低于T0时（P<0.05）。T1时2组患者OI比较差异无统计学意义（P＞0.05）；T2、T3、T4、T5时观察组患者OI显著高于对照组（P<0.05）。术前2组患者肺部HRCT图像未见异常；术后48 h，观察组患者肺部HRCT图像可见轻微“毛玻璃”样改变，对照组患者可见较明显“毛玻璃”样改变，且伴实变影。T0时2组患者血清IL-10、TNF-α、CC16水平比较差异无统计学意义（P＞0.05）。T0～T5，2组患者血清IL-10水平整体呈升高趋势（F=36.759、5.725，P<0.05）；T3、T4、T5时观察组患者血清IL-10水平显著高于对照组（P<0.05）。观察组患者T4时血清TNF-α水平显著高于T0时（P<0.05），对照组患者T3、T4、T5时血清TNF-α水平显著高于T0时（P<0.05）。T0、T1时2组患者血清TNF-α水平比较差异无统计学意义（P＞0.05）；T2、T3、T4、T5时，观察组患者血清TNF-α水平显著低于对照组（P<0.05）。对照组患者T3时血清CC16水平显著高于T0时（P<0.05）；T3、T4、T5时观察组患者血清CC16水平显著低于对照组（P<0.05）。2组患者均未出现呼吸抑制、心动过缓、低血压等不良反应事件。对照组和观察组患者术后吗啡使用率分别为19.6%（11/56）、0.0%（0/56），观察组患者术后吗啡使用率显著低于对照组（χ2=12.198，P<0.05）。结论　DEX有利于维持行OPCABG患者的血流动力学稳定，抑制机体炎症反应，减轻肺损伤。
Abstract:
Objective　To investigate the effect of dexmedetomidine (DEX) on the levels of serum interleukin-10 (IL-10),tumor necrosis factor-α (TNF-α) and Clara cell protein 16 (CC16) in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and the protective effect of DEX on lung.Methods　A total of 112 patients with coronary heart disease (CHD) who underwent OPCABG in the First Affiliated Hospital of Xinxiang Medical University from August 2016 to September 2018 were randomly divided into observation group and control group by random digits table,with 56 cases in each group.Twenty minutes before anesthesia induction,the patients in the observation group were intravenously injected with DEX 1 μg·kg-1,and the patients in the control group were intravenously injected with equal volume of normal saline.After the anastomosis of the first graft vessel,the patients in the observation group were given DEX 0.2-0.5 μg·kg-1·h-1 by intravenous drip to the end of the operation,and the patients in the control group were given the same volume of normal saline to the end of the operation.The mean arterial pressure (MAP),heart rate (HR),bispectral index (BIS),respiratory index (RI),oxygenation index (OI) and the levels of serum IL-10,TNF-α and CC16 at 30 minutes before anesthesia induction (T0),immediately after endotracheal intubation (T1),the end of operation (T2),and postoperative 12 hours (T3),24 hours (T4),48 hours (T5) were compared between the two groups.The lung injury was observed by high resolution computed tomography (HRCT) before operation and 48 hours after operation.The adverse reaction events and postoperative morphine using were observed in the two groups.Results　There was no significant difference in the MAP,HR,BIS,RI and OI between the two groups at T0 (P＞0.05).The MAP at T1,T2,T3,T4 and T5 in the observation group was significantly lower than that at T0 (P<0.05).The MAP at T1,T4 and T5 was significantly higher than that at T0,and the MAP at T2 and T3 was significantly lower than that at T0 in the control group (P<0.05).The HR at T1 and T2 was significantly lower than that at T0 in observation group (P<0.05).The HR at T1,T2,T3,T4 and T5 was significantly higher than that at T0 in the control group (P<0.05).The HR in the observation group was significantly lower than that in the control group at T1,T2,T3,T4 and T5 (P<0.05).The BIS at T1,T2,T3 and T4 was significantly lower than that at T0 (P<0.05).There was no significant difference in BIS between the two groups at T1,T2,T3,T4 and T5 (P＞0.05).The RI at T1,T2,T3,T4 and T5 was significantly higher than that at T0 in the control group (P<0.05).The RI at T1,T2,T3 and T4 was significantly higher than that at T0 in the observation group (P<0.05).The RI in the observation group was significantly lower than that in the control group at T1,T2,T3,T4 and T5 (P<0.05).The OI at T2,T3,T4 and T5 was significantly lower than that at T0 in the control group (P<0.05).The OI at T2,T3 and T4 in the observation group was significantly lower than that at T0 (P<0.05).There was no significant difference in the OI between the two groups at T1 (P＞0.05).The OI in the observation group was significantly higher than that in the control group at T2,T3,T4 and T5 (P<0.05).The HRCT images of lung were normal before operation in the two groups.Forty-eight hours after operation,the slight "ground glass" like changes could be seen in the HRCT images of the lung of the patients in the observation group,and more obvious "ground glass" like changes with consolidation shadow could be seen in the control group.There was no significant difference in the levels of serum IL-10,TNF-α and CC16 between the two groups at T0 (P＞0.05).From T0 to T5,the level of serum IL-10 in the two groups increased as a whole (F=36.759,5.725 P<0.05).The level of serum IL-10 in the observation group was significantly higher than that in the control group at T3,T4 and T5 (P<0.05).The level of serum TNF-α at T4 was significantly higher than that at T0 in the observation group (P<0.05).The level of serum TNF-α at T3,T4 and T5 was significantly higher than that at T0 in the control group (P<0.05).There was no significant difference in serum TNF-α level between the two groups at T0 and T1 (P＞0.05).The level of serum TNF-α in the observation group was significantly lower than that in the control group at T2,T3,T4 and T5 (P<0.05).The level of serum CC16 at T3 was significantly higher than that at T0 in the control group (P<0.05).The level of serum CC16 in the observation group was significantly lower than that in the control group at T3,T4 and T5 (P<0.05).There were no adverse events such as respiratory depression,bradycardia and hypotension in the two groups.The postoperative utilization rate of morphine in the control group and the observation group was 19.6% (11/56) and 0.0% (0/56),respectively.The postoperative utilization rate of morphine in the observation group was significantly lower than that in the control group(χ2=12.198,P<0.05).Conclusion　DEX is helpful to maintain the hemodynamic stability of patients undergoing OPCABG,inhibit the inflammatory response and reduce lung injury.

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更新日期/Last Update: 2021-09-05