摘要
目的探讨右美托咪定对机械通气患者血浆儿茶酚胺及炎性因子水平的影响。方法80例机械通气时间>48 h的患者随机均分为四组。机械通气前,四组均注射丙泊酚和负荷剂量右美托咪定0.6μg/kg,泵注时间15 min;随后分别予右美托咪定0.20(D1组)、0.35(D2组)、0.50(D3组)和0.65μg·kg^-1·h^-1(D4组)持续静脉泵注。检测机械通气前(T0)、通气后6 h(T1)、12 h(T2)、24 h(T3)和48 h(T4)各组MAP、HR以及血浆去甲肾上腺素、肾上腺素、TNF-α和IL-6的水平,记录不良反应发生情况。结果 T1~T4时,D2、D3和D4组的MAP、HR和去甲肾上腺素、肾上腺素水平均低于D1组(P<0.05)。T3、T4时,D2、D3和D4组TNF-α和IL-6水平均低于D1组(P<0.05)。D4组5例出现窦性心动过缓。结论右美托咪定0.35~0.50μg·kg^-1·h^-1泵注能有效抑制机械通气患者的应激反应和炎性反应,且不良反应较少。
Objective To investigate the effects of dexmedetomidine on plasma levels of catecholamines and inflammatory factors in the patients undergoing mechanical ventilation.MethodsEighty patients undergoing mechanical ventilation for more than 48 hours were randomly assigned into 4 groups with 20 cases each.Before established mechanical ventilation,the patients were intravenously injected propofol and a loading dose of dexmedetomidine 0.6 μg/kg in 15 minutes.Then the maintenance doses of dexmedetomidine 0.20(group D1),0.35(group D2),0.50(group D3) and 0.65μg·kg^-1·h^-1(group D4) were infused during mechanical ventilation. MAP and HR were mornitored continuously.Plasma levels of noradrenaline,adrenaline,TNF-α and IL-6 were detected before mechanical ventilation(T0) and at 6 hours(T1),12 hours(T2),24 hours(T3),and 48 hours(T4) during mechanical ventilation.The occurrence of adverse responses was recorded.ResultsMAP,HR and plasma concentrations of noradrenaline and adrenaline at T1 to T4 were lower in groups of D2,D3 and D4 than those in group D1(P<0.05).Plasma concentrations of TNF-α and IL-6 at T3 and T4 were lower in groups of D2,D3 and D4 than those in group D1(P<0.05).Sinus bradycardia occurred in 5 cases of group D4.Conclusion Continuous infusion of dexmedetomidine 0.35-0.50μg·kg^-1·h^-1 is able to effectively inhibit the stress response and inflammatory response in the patients undergoing mechanical ventilation with less adverse responses.
作者
端另波
张彤
李伯安
郑庆国
DUAN Lingbo;ZHANG Tong;LI Boan(Intensive Care Unit, Affiliated Third Hospital,Xuzhou Medical University,Xuzhou 221003,CHINA)
出处
《江苏医药》
CAS
2019年第5期497-499,共3页
Jiangsu Medical Journal
关键词
右美托咪定
儿茶酚胺
炎性因子
Dexmedetomidine
Catecholamine
Inflammatory factor
