摘要
目的探讨不同剂量右美托咪定对脓毒症相关性脑病(SAE)患者炎症反应、免疫功能及脑功能的影响。方法选择SAE患者60例根据右美托咪定维持剂量随机均分为L、M、H组,分别以0.2、0.4、0.6μg/(kg·h)维持,比较3组患者用药前(T_(0)),用药后12 h(T_(1))、24 h(T_(2))、72 h(T_(3))炎症因子(TNF⁃α、IL⁃6)、免疫功能(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))以及脑功能(SjvO_(2)、Da⁃jvO_(2)、CERO_(2)及S100β)指标,记录患者镇静期间不良反应、ICU住院时间及病死率。结果炎症反应及免疫功能:H组在T_(1)炎症反应及免疫功能较L组明显改善;H组在T_(2)炎症反应及免疫功能改善优于另外两组;T_(3)时,在减轻炎症及改善免疫抑制效果上,H组>M组>L组(P<0.05)。脑功能:H组在T_(2)、T_(3)时脑氧指标明显优于L、M组,同时在T_(3)时S100β明显低于L、M组(P<0.05)。3组患者心动过缓、低血压、ICU住院时间和病死率比较差异均无统计学意义(P>0.05)。结论右美托咪定维持剂量0.6μg/(kg·h)用于SAE患者镇静可以一定程度上减轻炎症反应及免疫抑制,改善脑氧代谢及脑功能,不增加不良反应发生率,且其效果随右美托咪定剂量的增加而提升。
Objective The aim of this study was to investigate the effects of different doses of dexmedeto⁃midine on inflammatory response,immune function and brain function in patients with sepsis⁃associated encepha⁃lopathy(SAE).Methods A total of 60 patients with SAE were enrolled and randomly divided into L,M,and H groups according to the different dose of dexmedetomidine.The above three groups were given dexmedetomidine 0.2,0.4 and 0.6μg/(kg·h)respectively.Inflammatory factors(TNF⁃αand IL⁃6),immune function(CD4^(+),CD8^(+) and CD4^(+)/CD8^(+))and brain function(SjvO_(2),Da⁃jvO_(2),CERO_(2) and S100β)before administration(T0),and 12 h(T_(1)),24 h(T_(2)),72 h(T_(3))after treatment were recorded and compared.Incidence of adverse reactions,length of stay in the ICU and mortality were also recorded.Results Inflammatory response and immune function:the inflammatory response and immune function of group H were significantly improved when comparing with group L at T_(1);Group H were better than the other two groups at T_(2) and T_(3) in inflammatory response and immune function;Group H>group M>group L in reducing inflammation and improving immune suppression at T_(3)(P<0.05).Brain function:the cerebral oxygen index of group H was significantly better than that in group L and M at T_(2) and T_(3),and the S100βat T_(3) was significantly lower than the other two groups(P<0.05).There was no significant difference in the incidence of bradycardia,hypotension,length of ICU stay and mortality among the three groups(P>0.05).Conclusion Dexmedetomidine could reduce inflammation and immunosuppression,improve cerebral oxygen metabolism and brain function with 0.6μg/(kg·h)treatment.It did not increase the incidence of adverse reactions and its effects would be more and more significant with the increase of dexmedetomidine dose.
作者
徐猛
王子文
谢叙
张林娜
XU Meng;WANG Ziwen;XIE Xu;ZHANG Linna(Department of Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2022年第20期2580-2584,共5页
The Journal of Practical Medicine
基金
徐州市科技局课题重点项目(编号:KC21214)。
关键词
脓毒症相关性脑病
右美托咪定
炎症因子
免疫抑制
脑损伤
sepsis⁃associated encephalopathy
dexmedetomidine
inflammatory factors
immuno⁃suppression
brain injury
