右美托咪定联合丙泊酚对ARDS机械通气患者应激水平及炎性因子的影响
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摘要
目的研究右美托咪定联合丙泊酚对ARDS机械通气患者应激水平及炎性因子的影响和镇静效果。方法选择2016年4月至2017年4月在我院ICU进行机械通气,时间>24 h的90例危重症患者,随机分为右美托咪定联合丙泊酚组(联合组)、右美托咪定组和丙泊酚组,每组30例,分别采用相应药物进行镇静。观察机械通气1、3、7 d时三组患者儿茶酚胺(肾上腺素、去甲肾上腺素)、炎性因子(TNF-α、IL-6)的水平,记录治疗期间各组低血压、心动过缓等不良反应发生率。结果三组患者治疗前后0.5 h的平均动脉压(MAP)、心率(HR)比较,差异有统计学意义(P<0.05)。联合组治疗后MAP为(70.7±9.4)mmHg,HR为(60.5±6.9)次/min,明显优于右美托咪定组和丙泊酚组,差异有统计学意义(P<0.05)。治疗后1、3、7 d,联合组AD、NE、IL-6、IL-10明显优于右美托咪定组和丙泊酚组,差异有统计学意义(P<0.05)。结论右美托咪定联合丙泊酚对ARDS机械通气患者的镇静效果较单独使用右美托咪定和丙泊酚显著,对抑炎因子IL-10的分泌有一定抑制作用,对疾病的治疗有积极作用,值得在临床上应用。
Objective To study the effect of dexmedetomidine combined with propofol on the levels of stress status and inflammatory factors and the sedative effect in ARDS patients with mechanical ventilation. Methods Totally 90 critically ill patients with mechanical ventilation time more than 24 h in ICU of our hospital from April 2016 to April 2017 were selected and randomly divided into 3 groups,30 cases in each group. Dexmedetomidine and propofol group( combination group),dexmedetomidine group and propofol group,which were treated with corresponding drugs for sedation.The levels of catecholamine( epinephrine and norepinephrine) and inflammatory factors( TNF-α and IL-6) of the three groups were observed at 1,3 and 7 d after mechanical ventilation,and the incidence of hypotension,bradycardia and other adverse events were recorded during the treatment. Results There were significant differences in MAP and HR at 0. 5 h before and after treatment among the three groups( P < 0. 05). The MAP of combination group was( 70. 7 ± 9. 4) mmHg,and HR was( 60. 5 ± 6. 9) bpm,which were superior to those of dexmedetomidine group and propofol group( P < 0. 05). At 1,3 and 7 d after treatment,the AD,NE,IL-6 and IL-10 in combination group were significantly better than those in dexmedetomidine group and propofol group( P < 0. 05). Conclusion The sedative effect of dexmedetomidine combined with propofol on patients with ARDS mechanical ventilation is significantly better than that of dexmedetomidine and propofol alone. It has certain inhibitory effect on the secretion of IL-10,and positive clinical efficacy,which is worthy of clinical application.
Objective To study the effect of dexmedetomidine combined with propofol on the levels of stress status and inflammatory factors and the sedative effect in ARDS patients with mechanical ventilation. Methods Totally 90 critically ill patients with mechanical ventilation time more than 24 h in ICU of our hospital from April 2016 to April 2017 were selected and randomly divided into 3 groups,30 cases in each group. Dexmedetomidine and propofol group( combination group),dexmedetomidine group and propofol group,which were treated with corresponding drugs for sedation.The levels of catecholamine( epinephrine and norepinephrine) and inflammatory factors( TNF-α and IL-6) of the three groups were observed at 1,3 and 7 d after mechanical ventilation,and the incidence of hypotension,bradycardia and other adverse events were recorded during the treatment. Results There were significant differences in MAP and HR at 0. 5 h before and after treatment among the three groups( P < 0. 05). The MAP of combination group was( 70. 7 ± 9. 4) mmHg,and HR was( 60. 5 ± 6. 9) bpm,which were superior to those of dexmedetomidine group and propofol group( P < 0. 05). At 1,3 and 7 d after treatment,the AD,NE,IL-6 and IL-10 in combination group were significantly better than those in dexmedetomidine group and propofol group( P < 0. 05). Conclusion The sedative effect of dexmedetomidine combined with propofol on patients with ARDS mechanical ventilation is significantly better than that of dexmedetomidine and propofol alone. It has certain inhibitory effect on the secretion of IL-10,and positive clinical efficacy,which is worthy of clinical application.
引文
[1]毛仲炫,林艳,杨瑞敏,等.丙泊酚联合瑞芬太尼靶控输注全凭静脉麻醉患者术中知晓的发生情况[J].临床麻醉学杂志,2013,29(11):1073-1075.
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[11]屈启才,胡平,思永玉,等.右美托咪定联合小剂量丙泊酚用于老年患者麻醉诱导时的气管插管反应[J].重庆医学,2017,46(6):827-829.
[12]Sinharoy P,Bratz IN,Sinha S,et al.TRPA1 and TRPV1 contribute to propofol-mediated antagonism of U46619-induced constriction in murine coronary arteries[J].PLoS One,2017,12(6):e0180106.
[13]梅弘勋,熊蔚,韩如泉.右美托咪定在颅脑手术麻醉中的应用[J].中国医药,2017,12(3):370-374.
[14]毋楠,张兴安,周巧梅,等.右美托咪啶联合丙泊酚对全麻手术患者血流动力学的影响[J].中国药房,2014,25(8):696-698.
[15]Bhutia MP,Rai A.Attenuation of haemodynamic parameters in response to pneumoperitoneum during laparoscopic cholecystectomy:a randomized controlled trial comparing infusions of propofol and dexmedetomidine[J].J Clin Diagn Res,2017,11(5):UC01-UC04.
[16]王玉玺,徐昌顺,蔡铁良,等.右美托咪定与丙泊酚在脑功能区术中唤醒麻醉中对应激反应的影响[J].中国医药,2016,11(11):1644-1648.
[17]Wakabayashi S,Yamaguchi K,Kumakura S,et al.Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy[J].Int J Mol Med,2014,34(1):137-144.
[18]蒙丽宇.右美托咪定对腹腔镜手术患者应激及炎性反应的影响[J].中国医药导报,2015,12(13):112-116.
[19]杜燕燕,彭学强,梁光宇,等.不同剂量右美托咪定对全麻下纤维支气管镜检查时气道反应的影响[J].海南医学院学报,2016,22(11):1175-1178.
[20]Liu Y,Yan Y,Inagaki Y,et al.Insufficient astrocyte-derived brain-derived neurotrophic factor contributes to propofol-induced neuron death through akt/glycogen synthase kinase 3β/mitochondrial fission pathway[J].Anesth Analg,2017,125(1):241-254.
[21]张伟,张加强,孟凡民.右美托咪定对单肺通气过程中炎性反应及氧化应激反应的影响[J].临床麻醉学杂志,2013,29(3):229-231.
[22]徐雪,蔡劲松,戚翔,等.不同剂量右美托咪定对大鼠全脑缺血再灌注损伤脑保护作用的研究[J].现代中西医结合杂志,2015,24(7):688-690,693.
[23]Kamal K,Asthana U,Bansal T,et al.Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging[J].Saudi J Anaesth,2017,11(2):163-168.
[24]刘光杰,白庆林,李海燕,等.右美托咪定联合丙泊酚对单肺通气患者的肺保护作用[J].中国临床医生杂志,2016,44(2):81-83.
[25]Gouda B,Gouda G,Borle A,et al.Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures:a meta-analysis[J].Saudi J Gastroenterol,2017,23(3):133-143.
[2]Mikkelsen MLG,Ambrus R,Rasmussen R,et al.The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia[J].Acta Vet Scand,2017,59(1):27.
[3]胡子龙,张志成,李大伟,等.右美托咪定联合丙泊酚在机械通气患者中的应用[J].解放军医学杂志,2015,40(6):479-483.
[4]Batra A,Verma R,Bhatia VK,et al.Dexmedetomidine as an Anesthetic Adjuvant in Intracranial Surgery[J].Anesth Essays Res,2017,11(2):309-313.
[5]杨芳,向林,张毅,等.右美托咪定在重症急性胰腺炎机械通气患者镇静中的应用[J].中国医药,2016,11(1):72-75.
[6]俞森洋.对急性呼吸窘迫综合征诊断新标准(柏林定义)的解读和探讨[J].中国呼吸与危重监护杂志,2013,12(1):1-4.
[7]Gupta S,Sharma R.Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries:a prospective,randomised,double-blinded clinical study[J].Indian J Anaesth,2017,61(6):499-504.
[8]卓帅,郑剑桥,刘斌.右美托咪啶和丙泊酚对术后ICU患者镇静效果的系统评价[J].中国循证医学杂志,2012,12(6):686-693.
[9]He FY,Feng WZ,Zhong J,et al.Effects of propofol and dexmedetomidine anesthesia on Th1/Th2 of rat spinal cord injury[J].Eur Rev Med Pharmacol Sci,2017,21(6):1355-1361.
[10]鹿兴,李军,徐磊.丙泊酚序贯右美托咪定对ICU躁动患者脱机过程中镇静效应的影响[J].实用医学杂志,2015,31(7):1179-1181.
[11]屈启才,胡平,思永玉,等.右美托咪定联合小剂量丙泊酚用于老年患者麻醉诱导时的气管插管反应[J].重庆医学,2017,46(6):827-829.
[12]Sinharoy P,Bratz IN,Sinha S,et al.TRPA1 and TRPV1 contribute to propofol-mediated antagonism of U46619-induced constriction in murine coronary arteries[J].PLoS One,2017,12(6):e0180106.
[13]梅弘勋,熊蔚,韩如泉.右美托咪定在颅脑手术麻醉中的应用[J].中国医药,2017,12(3):370-374.
[14]毋楠,张兴安,周巧梅,等.右美托咪啶联合丙泊酚对全麻手术患者血流动力学的影响[J].中国药房,2014,25(8):696-698.
[15]Bhutia MP,Rai A.Attenuation of haemodynamic parameters in response to pneumoperitoneum during laparoscopic cholecystectomy:a randomized controlled trial comparing infusions of propofol and dexmedetomidine[J].J Clin Diagn Res,2017,11(5):UC01-UC04.
[16]王玉玺,徐昌顺,蔡铁良,等.右美托咪定与丙泊酚在脑功能区术中唤醒麻醉中对应激反应的影响[J].中国医药,2016,11(11):1644-1648.
[17]Wakabayashi S,Yamaguchi K,Kumakura S,et al.Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy[J].Int J Mol Med,2014,34(1):137-144.
[18]蒙丽宇.右美托咪定对腹腔镜手术患者应激及炎性反应的影响[J].中国医药导报,2015,12(13):112-116.
[19]杜燕燕,彭学强,梁光宇,等.不同剂量右美托咪定对全麻下纤维支气管镜检查时气道反应的影响[J].海南医学院学报,2016,22(11):1175-1178.
[20]Liu Y,Yan Y,Inagaki Y,et al.Insufficient astrocyte-derived brain-derived neurotrophic factor contributes to propofol-induced neuron death through akt/glycogen synthase kinase 3β/mitochondrial fission pathway[J].Anesth Analg,2017,125(1):241-254.
[21]张伟,张加强,孟凡民.右美托咪定对单肺通气过程中炎性反应及氧化应激反应的影响[J].临床麻醉学杂志,2013,29(3):229-231.
[22]徐雪,蔡劲松,戚翔,等.不同剂量右美托咪定对大鼠全脑缺血再灌注损伤脑保护作用的研究[J].现代中西医结合杂志,2015,24(7):688-690,693.
[23]Kamal K,Asthana U,Bansal T,et al.Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging[J].Saudi J Anaesth,2017,11(2):163-168.
[24]刘光杰,白庆林,李海燕,等.右美托咪定联合丙泊酚对单肺通气患者的肺保护作用[J].中国临床医生杂志,2016,44(2):81-83.
[25]Gouda B,Gouda G,Borle A,et al.Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures:a meta-analysis[J].Saudi J Gastroenterol,2017,23(3):133-143.