右美托咪定对脓毒症相关性脑病患者炎症因子及S100β蛋白的影响

Effects of dexmedetomidine on inflammatory response and S100 beta protein in patients with sepsis associated encephalopathy

摘要:

目的 分析右美托咪定和异丙酚对脓毒症相关性脑病(SAE)患者炎性因子及S100β蛋白的影响。方法 入选徐州医科大学附属医院重症监护病房(ICU)2017年7月至2018年12月行机械通气的SAE患者50例,随机数表法分为异丙酚组和右美托咪定组,每组25例。分别接受异丙酚和右美托咪定治疗,比较2组患者用药后1h(T1)、12h(T2)、24h(T3)、3d(T4)白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和中枢神经特异性蛋白S100β水平,以及不良反应、死亡率和留住ICU时间。应用SPSS 20.0统计软件对数据进行分析。依据数据类型,采用t检验或χ²检验进行组间比较。结果 右美托咪定组相比异丙酚组患者T2、T3、T4时间点TNF-α[(17.83±2.09)和(19.96±2.65)ng/L；(14.95±3.37)和(18.83±4.46)ng/L；(8.62±3.07)和(17.75±5.06)ng/L]、S100β蛋白[(0.69±0.05)和(0.61±0.04)μg/L；(0.62±0.03)和(0.55±0.03)μg/L；(0.56±0.02)和(0.42±0.01)μg/L]水平低,T3、T4时间点IL-6[(340.71±10.37)和(390.89±12.26)ng/L；(240.62±10.54)和(331.15±12.64)ng/L]水平低,差异均有统计学意义(P＜0.05)。右美托咪定组患者1例呼吸抑制,4例心动过缓,2例低血压；异丙酚组患者2例呼吸抑制,3例心动过缓,4例低血压。右美托咪定组相比异丙酚组患者不良反应发生率[28%(7/25)和36%(9/25)]差异无统计学意义(P＞0.05)。右美托咪定组患者4例死亡,入住ICU时间(13.19±2.26)d,异丙酚组患者2例死亡,入住ICU时间(13.07±2.16)d,2组预后比较差异均无统计学意义(P＞0.05)。结论 右美托咪定用于SAE患者可一定程度减轻炎症反应,获得理想的镇静效果。

Abstract:

Objective To determine the effects of dexmedetomidine and propofol on inflammatory response and S100β protein in patients with sepsis associated encephalopathy (SAE). Methods A total of 50 SAE patients undergoing mechanical ventilation admitted to the intensive care unit (ICU) of our hospital from July 2017 to December 2018 were prospectively enrolled in this study. They were randomly divided into propofol group and dexmedetomidine group, 25 cases in each group. The levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and central nervous system specific protein S100β at 1 (T1), 12 (T2) and 24 h (T3), and 3 d (T4) after the treatment, incidence of adverse reactions, mortality and length of ICU stay were compared between the 2 groups. SPSS statictis 20.0 was used to analyze the data. Student′s t test or Chi-square test was employed for intergroup comparison. Results The levels of TNF-α at T2, T3 and T4 [(17.83±2.09) vs (19.96±2.65)ng/L, (14.95±3.37) vs (18.83±4.46)ng/L, (8.62±3.07) vs(17.75±5.06)ng/L], those of S100β [(0.69±0.05) vs (0.61±0.04)μg/L, (0.62±0.03) vs (0.55±0.03)μg/L, (0.56±0.02) vs (0.42±0.01)μg/L] at the same time points, and those of IL-6 [(340.71±10.37) vs (390.89±12.26)ng/L, (240.62±10.54) vs (331.15±12.64)ng/L] at T3 and T4 were significantly lower in the dexmedetomidine group than the propofol group (P<0.05). There were 1 case of respiratory depression, 4 cases of bradycardia and 2 cases of hypotension in the dexmedetomidine group, and 2 cases of respiratory depression, 3 cases of bradycardia, and 4 cases of hypotension in the propofol group. No statistical difference was seen in the incidence of adverse reactions between the 2 groups [28%(7/25) vs 36%(9/25), P>0.05]. In the dexmedetomidine group, 4 patients died, and the length of ICU stay was (13.19±2.26)d. For the propofol group, 2 patients died, and ICU length was (13.07±2.16)d. There was no differences in the mortality and ICU length between the 2 groups (P>0.05). Conclusion Dexmedetomidine can attenuate inflammatory response to some extent and achieve ideal sedative effect in SAE patients.