Department of Anaesthesiology and Reanimation, Trakya University Medical Faculty, 22030 Edirne, Turkey.
J Clin Anesth. 2009 Sep;21(6):394-400. doi: 10.1016/j.jclinane.2008.10.010.
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.
Prospective, single-center study.
University hospital.
40 adult ICU patients who had undergone ileus surgery and who were expected to require postoperative sedation and ventilation.
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.
Biochemical and hemodynamic parameters, cytokine levels, and IAP were recorded before the start of the study and at the 24th and 48th hours.
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.
Dexmedetomidine infusion decreases TNF-a, IL-1, and IL-6 levels and IAP more than a propofol infusion.
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。
前瞻性，单中心研究。
大学医院。
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。
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）。
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。
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。
右美托咪定输注比异丙酚输注降低 TNF-a、IL-1 和 IL-6 水平和 IAP 更显著。
