摘要
目的探讨右美托咪定在行心脏瓣膜置换术中年患者脑代谢中的影响及脑保护作用中的机制。方法择期行体外循环下心脏瓣膜置换术中年患者58例,按照随机数字表法分为右美托咪定组和对照组各29例,右美托咪定组在麻醉诱导前静脉注射右美托咪定0.6μg/kg,15min内注射完毕,之后以0.2μg/(kg·h)速率静脉泵注至术毕;对照组麻醉诱导前静脉注射等量生理盐水,并以相同速率静脉泵注生理盐水至术毕。记录2组体外循环前(T1)、升主动脉开放(T2)、体外循环结束后10min(T3)、术后6h(T4)时颈静脉血氧饱和度(jugularn venous oxygen saturation,SjvO2)、动脉-颈内静脉血氧含量差(arterial venous oxygen content difference,Da-jvO2)及脑氧摄取率(cerebral extraction of oxygen,CERO2),并分别于T1、T2、T3、T4时间点及术后24h(T5)测定2组血浆S-100β蛋白及神经元特异性烯醇化酶(neuronspecific enolase,NSE)水平。结果右美托咪定组T2时间点SjvO2[(70.0±5.0)%]高于T1[(64.0±8.0)%],Da-jvO2[(23.0±9.0)mmol/L]和CERO2[(18.0±6.0)%]低于T1[(50.0±10.0)mmol/L、(36.0±10.0)%](P<0.05);对照组T2时间点SjvO2[(83.0±9.0)%]高于T1[(64.0±10.0)%],Da-jvO2[(35.0±8.0)mmol/L]和CERO2[(28.0±5.0)%]低于T1[(53.0±9.0)mmol/L、(37.0±9.0)%](P<0.05);2组T2、T3、T4时间点S-100β蛋白、NSE水平高于T1(P<0.05);右美托咪定组T2、T3时间点SjvO2高于对照组,Da-jvO2、CERO2低于对照组(P<0.05),T2、T3、T4时间点S-100β蛋白及NSE水平均低于对照组(P<0.05)。结论行心脏瓣膜置换中年患者术中应用右美托咪定可改善脑氧代谢,减少术中可能出现的脑缺血缺氧状态,一定程度上具有脑保护作用。
Objective To explore the effect of dexmedetomidine on cerebral metabolism and mechanism of cerebral protection in middle-aged patients with cardiac valve replacement. Methods Fifty-eight middle-aged patients receiving cardiac valve replacement under extracorporeal circulation were divided into dexmedetomidine group and control group, with 29 patients in each group according to random number table. Dexmedetomidine group was injected 0. 6 μg/kg dexmedetomidine within 15 rain before the induction of anesthesia, followed by intravenous infusion of 0.2 μg/（kg ·h） dexmedetomidine till the end of operation. Control group was injected the same volume of normal saline and was infused at the same speed. The jugularn venous oxygen saturation （SjvO2）, arterial venous oxygen content difference （Da-jvO2） and cerebral extraction of oxygen （CERO2） were recorded at the time points of T1 （before cardiopulmonary bypass）, T2 （when the ascending aorta was open）, T3 （after cardiopulmonary bypass） and T4 （6 hours after operation） were recorded. And S- 100β protein and neuron-specific enolase （NSE） were detected at the time points of T1, T2, T3, T4 and Ts （after operation） in two groups. Results In dexmedetomidine group, SjvO2 was higher, and Da-jvO2 and CERO2 were lower at T2（（70.0±5.0）%, （23.0±9.0） mmol/L, （18.0±6.0） %） than those at Tl（（64.0±8.0）%, （50.0±10.0） mmol/L, （36.0±10.0）%） respectively （P〈0.05）. In control group, SjvO2 was higher, and Da-jvO2 and CERO2 were hower at T2 （（83.0±9.0）%, （35.0±8.0） mmol/L, （28.0±5.0） %） than those at T1 （（64.0±10.0）%, （53.0±9.0） mmol/L, （37.0±9.0） %） （P〈0.05）. S-100β proteins at T2, T3 and T4 and NSE were higher than those at T1 （P〈0.05） in both two group （P（0.05）. SjvO2 values at T2 and T3 were higher, Da-jvO2 and CERO2 were lower, and S-10013 protein and NSE at T2, T3 and T4 were lower in dexmedetomidine group than those in control group （P〈0.05）. Conclusion Dexmedetomidine can improve cerebral metabolism, relieve cerebral ischemia-hypoxia and has cerebral protective effect.
出处
《中华实用诊断与治疗杂志》
2016年第2期193-195,共3页
Journal of Chinese Practical Diagnosis and Therapy
关键词
心脏瓣膜置换术
右美托咪定
体外循环
脑代谢
脑保护
Cardiac valve replacement
dexmedetomidine
extraeorporeal circulation
cerebral metabolism
cerebral proteetion
作者简介
通信作者：郝建华，E—mail：hnwmdqc@126．com。
