摘要
目的 探讨右美托咪啶对颅脑损伤患者术中Toll样受体4(TLR4)-核因子(NF)-κB信号通路水平的影响.方法 前瞻性将2021年6月至2022年12月太原钢铁(集团)有限公司总医院收治的82例颅脑损伤患者纳入研究,按照随机数字表法分为实验组(n=41)与对照组(n=41).两组患者于麻醉诱导前给予盐酸戊乙奎醚,以舒芬太尼、丙泊酚、顺阿曲库铵进行麻醉诱导,以瑞芬太尼、七氟烷、丙泊酚维持麻醉.实验组于麻醉诱导前10 min给予右美托咪啶,对照组以等量0.9％氯化钠溶液代替右美托咪啶.记录两组不同麻醉药物使用情况;术前(T0)、术毕(T1)、术后24 h(T2)时,检测比较两组肌酸激酶BB(CK-BB)、颅内压水平、炎症因子[白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)]水平及TLR4-NF-κB信号通路表达情况.结果 两组不同麻醉药物剂量比较,差异均无统计学意义(P＞0.05).T0、T1时,两组CK-BB、颅内压水平组间比较,差异均无统计学意义(P＞0.05);T2时,实验组CK-BB、颅内压水平均明显低于对照组,差异均有统计学意义(P＜0.05).T0时,两组IL-6、IL-1β、TNF-α水平组间比较,差异均无统计学意义(P＞0.05);T1、T2时,实验组IL-6、IL-1β、TNF-α水平均明显低于对照组,差异均有统计学意义(P＜0.05)(P＜0.05).T0时,两组TLR4 mRNA、NF-KB mRNA、TLR4蛋白、NF-κB蛋白水平组间比较,差异均无统计学意义(P＞0.05);T1、T2时,实验组TLR4 mRNA、NF-κB mRNA、TLR4蛋白、NF-κB蛋白水平句明显低于对照组,差异均有统计学意义(P＜0.05)(P＜0.05).结论 右美托咪啶在颅脑损伤患者术中可有效改善患者脑损伤,减轻体内炎症反应,可能与抑制TLR4-NF-κB信号通路有关.
Abstract
Objective To investigate the effect of dexmedetomidine on toll-like receptor 4(TLR4)-nuclear factor(NF)-κB signa-ling pathway in patients with craniocerebral injury during operation.Methods A total of 82 patients with craniocerebral injury admitted to General Hospital of Taiyuan Steel(Group)Co.,Ltd.from June 2021 to December 2022 were included in the study and divided into experimental group(n=41)and control group(n=41)according to random number table method.Pentylequidine hydrochloride was administered before anesthe-sia induction,with sufentanil,propofol,and cisatracurium used for anesthesia induction,while remifentanil,sevoflurane,and propofol used for maintain anesthesia in two groups of patients.The experimental group was given dexmedetomidine 10 min before anesthesia induction,and the con-trol group was given the same amount of normal saline instead of dexmedetomidine.The use of different narcotic drugs was recorded in the two groups.Before surgery(T0),after surgery(T1),24 h after surgery(T2),the levels creatine kinase BB(CK-BB),intracranial pressure,in-flammatory factors[interleukin-6(IL-6),interleukin-1 β(IL-1 β),tumor necrosis factor-α(TNF-α)]and TLR4-NF-κB signaling pathway expression were detected and compared between the two groups.Results There were no significant differences in the dosage of different anesthetic drugs between the two groups(P＞0.05).At T0 and T1,there were no differences in the levels of CK-BB and ICP between the two groups(P＞0.05).At T2,the levels of CK-BB and intracranial pressure in experimental group were significantly lower than those in control group,the differences were statistically significant(P＜0.05).At T0,there were no differences in the levels of IL-6,IL-1 β and TNF-α be-tween the two groups(P＞0.05);at T1 and T2,the levels of IL-6,IL-1 β and TNF-α in experimental group were significantly lower than those in control group,the differences were statistically significant(P＜0.05).At T0,there were no differences in TLR4 mRNA,NF-κB mR-NA,TLR4 protein and NF-κB protein levels between the two groups(P＞0.05);at T1 and T2,the levels of TLR4 mRNA,NF-κB mRNA,TLR4 protein and NF-κB protein in experimental group were significantly higher than those in control group,the differences were statistically sig-nificant(P＜0.05).Conclusion Dexmedetomidine can effectively improve craniocerebral injury and reduce inflammation in vivo in patients with cranial injury during operation,which may be related to the inhibition of TLR4-NF-κB signaling pathway.
维普
万方数据