河北医科大学学报 ›› 2020, Vol. 41 ›› Issue (12): 1455-1459.doi: 10.3969/j.issn.1007-3205.2020.12.020

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右美托咪定对体外循环手术患儿Th1/Th2平衡的影响

  

  1. 河北医科大学第一医院麻醉科，河北 石家庄 050031
  • 出版日期:2020-12-25 发布日期:2021-01-04
  • 作者简介:郭琼梅（1980-），女，河北平山人，河北医科大学第一医院副主任医师，医学硕士，从事临床麻醉学研究。
  • 基金资助:
    河北省医学科学研究重点课题计划（20160197）

Effects of dexmedetomidine on the balance of Th1/Th2 in pediatric patients under cardiopulmonary bypass

  1. Department of Anesthesiology, the First Hospital of Hebei Medical University, Shijiazhuang 050031, China
  • Online:2020-12-25 Published:2021-01-04

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摘要： 目的 探讨右美托咪定对体外循环(cardiopulmonary bypass,CPB)手术患儿辅助性T细胞（helper T cell，Th）1/Th2平衡的影响。
方法 选择择期CPB下行室间隔缺损修补术患儿80例，年龄4~8岁，美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅱ或Ⅲ级，采用随机数字表法分为2组：对照组和右美托咪定组，每组40例。所有患儿静脉注射咪唑安定0.15 mg/kg，舒芬太尼1 μg/kg，依托咪酯0.3 mg/kg，罗库溴铵0.6 mg/kg麻醉诱导，右美托咪定组给予初始剂量1 μg/kg右美托咪定泵注（给药时间＞10 min），然后以0.5 μg·kg-1·h-1的速率维持至术毕，对照组同样的方法给予等容量生理盐水。分别于CPB开始前（T1）、CPB开始后30 min（T2）、CPB停止即刻（T3）、CPB停止后24 h（T4）和CPB停止后72 h（T5）采集动脉血样，流式细胞术检测血浆肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素 (interleukin，IL) -6、干扰素γ（interferon-γ，IFN-γ）和IL-4的水平。
结果 2组患儿血浆IL-4水平呈先升高后降低趋势，右美托咪定组IL-4水平在T2~4时低于对照组，组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。2组患儿血浆IFN-γ、IFN-γ/IL-4水平呈先降低后升高趋势，右美托咪定组IFN-γ、IFN-γ/IL-4水平在T2~4时高于对照组，组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。2组患儿血清TNF-α、IL-6水平呈先升高后降低趋势，右美托咪定组TNF-α、IL-6水平在T2~4时低于对照组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05）。
结论 右美托咪定能够减轻CPB引起的Th1/Th2向Th2漂移，缓解机体免疫抑制状态，减轻围术期炎症反应。

关键词: 右美托咪定, 体外循环, Th1/Th2平衡

Abstract: Objective To investigate the effects of dexmedetomidine on the balance of Th1/Th2 in pediatric patients under cardiopulmonary bypass. 
Methods Eighty pediatric patients，aged 4-8 years，of American Society of Anesthesiologists(ASA) physical statusⅡ or Ⅲ，scheduled for elective repair of ventricular septal defect under CPB, were randomly divided into 2 groups(n=40 each) using a random number table：control group(group C) and dexmedetomidine groups(group D). Anesthesia was induced with midazolam 0.15 mg/kg, sufentanyl 1 μg/kg, etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg．The patients were endotracheally intubated and mechanically ventilated．In group D， dexmedetomidine 1 μg/kg(initial dose) 〖JP2〗was given over more than 10 min，followed by continuous infusion at 0.5 μg·kg-1·〖JP〗h-1, until the end of operation．The equal volume of normal saline was given instead of dexmedetomidine in group C． Before CPB(T1)， 30 min after begainning of CPB(T2), at the immiadiately of the end of CPB(T3), at 24 and 72 h after the end of CPB(T4, T5)， blood samples were collected for determination of plasma tumor necrosis factor-a(TNF-α)， interleukin-6(IL-6), interferon-γ（IFN-γ） and interleukin-4(IL-4) concentrations. 
Results The plasma IL-4 levels showed ascending and descending trends, and were decreased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). The plasma IFN-γ and IFN-γ/ IL-4 levels showed descending and ascending trends in two groups, and were increased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). The plasma TNF-α and IL-6 levels show ascending and descending trends in two groups, and were decreased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). 
Conclusion Dexmedetomidine can inhibit immunomodulatory effects shifting the Th1/Th2 balance toward Th2 induced by CPB, alleviate perioperative inflammatory response.

Key words: dexmedetomidine, cardiopulmonary bypass, Th1/Th2 balance

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