一项关于异丙酚和右美托咪定对严重脓毒症炎症反应和腹腔内压影响的初步研究结果。

Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis.

机构信息

Department of Anaesthesiology and Reanimation, Trakya University Medical Faculty, 22030 Edirne, Turkey.

出版信息

J Clin Anesth. 2009 Sep;21(6):394-400. doi: 10.1016/j.jclinane.2008.10.010.

DOI:10.1016/j.jclinane.2008.10.010

PMID:19833271

Abstract

STUDY OBJECTIVE

To compare the effects of an intravenous infusion of propofol and the alpha-2 adrenoceptor, dexmedetomidine, on inflammatory responses and intraabdominal pressure (IAP) in severe sepsis after abdominal surgery, specifically, serum cytokine levels (interleukin [IL]-1, IL-6, and tumor necrosis factor [TNF]-alpha) and IAP.

DESIGN

Prospective, single-center study.

SETTING

University hospital.

PATIENTS

40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation.

INTERVENTIONS

Patients received either a loading dose infusion of propofol (Group P; n = 20) one mg/kg over 15 minutes followed by a maintenance dose of one to three mg/kg/hr (n = 20, Group P) or a loading dose of dexmedetomidine of one microg/kg over 10 minutes followed by a maintenance dose of 0.2-2.5 microg/kg/h (n = 20, Group D) at the 24th hour.

MEASUREMENTS

Biochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours.

MAIN RESULTS

TNF-alpha levels were significantly lower at the 24th hour (14.66 +/- 4.40 pg/mL vs. 21.21 +/- 11.37 pg/mL, respectively) and at the 48th hour (21.25 +/- 15.85 pg/mL vs. 46.55 +/- 35.99 pg/mL, respectively) in Group D. IL-1 levels were significantly lower at the 24th hour (5.03 +/- 0.15 pg/mL vs. 6.23 +/- 2.09 pg/mL, respectively) and the 48th hour (5.01 +/- 0.37 pg/mL vs. 6.42 +/- 2.76 pg/mL, respectively) in Group D. IL-6 levels were significantly lower at the 24th hour (253.1 +/- 303.6 pg/mL and 511.3 +/- 374.8 pg/mL, respectively) and at the 48th hour (343.5 +/- 393.4 pg/mL and 503.7 +/- 306.4 pg/mL, respectively) in Group D. Intraabdominal pressure also was significantly lower at the 24th hour (12.35 +/- 5.84 mmHg vs. 18.1 +/- 2.84 mmHg, respectively) and the 48th hour (13.9 +/- 6.15 mmHg vs. 18.7 +/- 3.46 mmHg, respectively) in Group D.

CONCLUSION

Dexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.

摘要

研究目的

比较异丙酚和 α-2 肾上腺素能受体，右美托咪定，在腹部手术后严重脓毒症中的炎症反应和腹腔内压（IAP）的影响，特别是血清细胞因子水平（白细胞介素[IL]-1，IL-6 和肿瘤坏死因子[TNF]-alpha）和 IAP。

设计

前瞻性，单中心研究。

地点

大学医院。

患者

40 名接受过肠梗阻手术的成年 ICU 患者，预计需要术后镇静和通气。

干预措施

患者在第 24 小时分别接受异丙酚负荷剂量输注（组 P；n = 20）1 毫克/千克，持续 15 分钟，然后维持剂量为 1 至 3 毫克/千克/小时（n = 20，组 P）或右美托咪定负荷剂量 1 微克/千克，持续 10 分钟，然后维持剂量 0.2-2.5 微克/千克/小时（n = 20，组 D）。

测量

在研究开始前和第 24 小时和第 48 小时记录生化和血流动力学参数、细胞因子水平和 IAP。

主要结果

在第 24 小时（14.66 +/- 4.40 pg/mL 对 21.21 +/- 11.37 pg/mL）和第 48 小时（21.25 +/- 15.85 pg/mL 对 46.55 +/- 35.99 pg/mL），组 D 的 TNF-alpha 水平显著降低。第 24 小时（5.03 +/- 0.15 pg/mL 对 6.23 +/- 2.09 pg/mL）和第 48 小时（5.01 +/- 0.37 pg/mL 对 6.42 +/- 2.76 pg/mL），组 D 的 IL-1 水平显著降低。第 24 小时（253.1 +/- 303.6 pg/mL 和 511.3 +/- 374.8 pg/mL）和第 48 小时（343.5 +/- 393.4 pg/mL 和 503.7 +/- 306.4 pg/mL），组 D 的 IL-6 水平显著降低。第 24 小时（12.35 +/- 5.84 mmHg 对 18.1 +/- 2.84 mmHg）和第 48 小时（13.9 +/- 6.15 mmHg 对 18.7 +/- 3.46 mmHg），组 D 的 IAP 也显著降低。