摘要
目的研究右美托咪定对体外循环(CPB)下心脏瓣膜置换术患者的脑保护作用。方法以2015年1月—2015年12月于郑州市第七人民医院择期进行CPB下心脏瓣膜置换手术的患者80例为研究对象,根据实施手术的时间顺序分为观察组和对照组,每组40例,观察组在麻醉诱导前及手术中使用右美托咪定,对照组给予相同剂量的生理盐水,比较两组的麻醉诱导前(T_0)、升主动脉开放时(T_1)、CPB结束后10 min(T_2)以及术后6 h时(T_3)4个时间点的动脉-静脉血氧含量差(Da-jvO_2)、颈内静脉血氧饱和度(SjvO_2)以及脑氧摄取率(CERO2)、血浆髓鞘碱性蛋白(MBP)、血清神经元特异性烯醇化酶(NSE)和S100β蛋白水平;手术前及手术后5 d的简易智力量表(MMSE)评分及认知功能障碍(POCD)发生率。结果 T_0和T_3时,两组的SjvO_2、Da-jvO_2和CERO2比较,差异无统计学意义;T_1时,两组的SjvO_2较T_0时升高(P<0.05),Da-jvO_2和CERO2较T_0时降低(P<0.05);T_1和T_2时,观察组的SjvO_2高于对照组,Da-jvO_2和CERO2低于对照组(P<0.05);T_2、T_3时,观察组和对照组的MBP水平均高于T_0时(P<0.05),且观察组MBP水平低于对照组(P<0.05);T_1、T_2、T_3时,观察组和对照组的NSE和S100β水平均较T_0时显著升高(P<0.05),观察组的NSE水平在T_1、T_2、T_3时均低于对照组(P<0.05),S-100β水平在T_2、T_3时均低于对照组(P<0.05);术后5 d,观察组的MMSE评分与术前比较,差异无统计学意义(P<0.05),对照组的MMSE评分显著低于术前(P<0.05);观察组术后7 d的MMSE评分高于对照组,POCD发生率低于对照组(P<0.05)。结论 CPB下心脏瓣膜置换术患者术中使用右美托咪定可显著改善患者的脑缺血缺氧状态,减轻脑损伤。
Objective To investigate the cerebral protection of dexmedetomidine in patients with heart valve replacement under CPB. Methods Totally 80 cases of patients with heart valve replacement under CPB in Seventh people＇s hospital of Zhengzhou city from January 2015 to December 2015 were selected and divided into observation group and control group, 40 cases in each group. Patients in observation group were treated with dexmedetomidine before anesthetic induction and during the operation, and patients in control group were treated with same dose of saline solution. The arterio-venous oxygen content difference （Da-jvO2）, jugular venous oxygen saturation （SjvO2）, cerebral oxygen extraction rate （CERO2）, serum myelin basic protein （MBP）, serum neuron-specific enolase （NSE）, and S 10013 protein content before anesthetic induction （To） and when the ascending aorta open （T1）, After 10 min of CPB （T2） and postoperative 6 h （T3） were compared between two groups, and occurring rates of MMSE and POCD were also compared. Results SjvO2 values of two groups at T1 were significant higher than To （P 〈 0.05）, Da-jvO2, and CERO2 were significant lower than To （P 〈 0.05）, SjvO2 values of observation group at T1 and T2 were significant higher than those of control group and Da-jvO2 and CERO2 were significant lower than those of control group （P 〈 0.05）; At T2 and T3, MBP levels of observation group and control group were significant higher than To （P 〈 0.05）, and those in observation group were significant lower than control group （P 〈 0.05）; At T1, T2, and T3 of observation group and control group were significant higher than To （P 〈 0.05）, and NSE levels of observation group at T1, T2, T3 were significant lower than those of control group （P 〈 0.05）, S-100β levels of observation group at T2 and T3 were significant lower than those of control group （P 〈 0.05）. After 7 d, MMSE score of observation group was significant higher than that of control group and POCD occurring rate was lower （P 〈 0.05）. Conclusion Dexmedetomidine can improve cerebral ischemia hypoxia state and reduce brain damage in patients with heart valve replacement under CPB.
作者
朱雅萍
宋一民
宋磊军
魏金聚
ZHU Ya-ping SONG Yi-min SONG Lei-jun WEI Jin-ju(Anesthesia department, Seventh people＇s hospital of Zhengzhou city, Zhengzhou 450000, China Department of pathology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China)
出处
《药物评价研究》
CAS
2017年第3期356-360,共5页
Drug Evaluation Research
作者简介
朱雅萍（1980-），女，本科，主治医师，研究方向为心血管麻醉的管理及药物应用。Tel：13663868965 E-mail：zhuyaping_198009@medicinepaper．cn
