摘要
目的 探讨右美托咪定（dexmedetomidine,Dex）对小儿先天性心脏病（congenital heart disease,CHD）CPB术中脑氧代谢及近远期认知功能的影响. 方法 择期行CPB手术的CHD患儿84例,采用随机数字表法分为观察组和对照组（每组42例）.观察组麻醉诱导后予以吸入2.5％七氟醚及Dex 0.4 μg· kg^-1·h^-1术中维持麻醉,对照组麻醉诱导后予以吸入2.5％七氟醚维持麻醉,分别在患儿CPB开始前（T1）、升主动脉开放时（T2）、CPB结束10 min（T3）、术后6 h（T4）4个时间点分别采集3 ml的桡动脉及静脉球部血样进行血气分析,计算颈内静脉血氧饱和度（jugular venous oxygen saturation,SjvO2）、动脉-颈内静脉血氧含量差值（arterial venous oxygen content difference,Da-jvO2）以及脑氧摄取率水平（cerebral extraction of oxygen,CERO2）,并在术前、术后3d、术后3个月、术后1年行简易智力状况调查（mini-mental state examination,MMSE）评分. 结果 两组患儿T2时SjvO2高于T1时,而Da-jvO2、CER02低于T1时,差异有统计学意义（P＜0.05）;T2时观察组SjvO2高于对照组,而Da-jvO2、CER02低于对照组,差异有统计学意义（P＜0.05）,而T3、T4时两组患儿SjvO2、Da-jvO2、CERO2的差异无统计学意义（P＞0.05）.两组患儿术前MMSE评分差异无统计学意义（P＞0.05）;观察组术后4d和术后3个月的MMSE评分[（26.5±1.5）、（27.6±1.6）分]显著高于对照组[（24.3±1.3）、（25.8±1.5）分],差异有统计学意义（P＜0.05）;两组术后1年的MMSE评分差异无统计学意义（P＞0.05）. 结论 小儿CHD CPB术中应用Dex具有一定的脑保护作用,能改善脑氧代谢以及术后短期认知功能.
Objective Exploring the effects of dexmedetomidine （Dex） on cerebral oxygen metabolism and postoperative cognitive function during cardiopulmoary bypass of pediatric congenital heart disease （CHD） surgery.Methods Eighty-four children with cardiopulmonary bypass of CHD surgery were randomly divided into observation group and control group （n=42）.2.5% sevoflurane and Dex 0.4 μg·kg^-1·h^-1 was applied during maintenance of anesthesia in observation group,while only 2.5% sevoflurane was applied in control group.At the time points of before beginning cardiopulmonary bypass （T1）,of the ascending aorta was open（T2）,of ending cardiopulmonary bypass（T3） and of 6 hours after operation（T4）,blood from radial artery and right jugular bulb were harvested for blood gas analysis.The jugular venous oxygen saturation （SjvO2）,arterial venous oxygen content difference （Da-jvO2） and cerebral extraction of oxygen （CERO2） were calculated according blood gas analysis.The mini-mental state examination （MMSE） score were evaluated before and 4 day,3 month and 1 year after surgery.Results The SjvO2 of T2 were higher than SjvO2 of T1 in two groups,but Da-jvO2 and CERO2 were lower than Da-jvO2 and CERO2 of T1.The differences were statistically significant （P〈0.05）.The SjvO2 in observation group at T2 was higher than SjvO2 at T2 in control group,but Da-jvO2 and CERO2 at T2 were lower than those in control group.The differences were statistically significant （P〈0.05）.There were no significant differences in SjvO2,Da-jvO2,CERO2 at T3,T4 between two groups （P〉0.05）.There were no significant differences in preoperative MMSE scores between two groups （P〉0.05）.The MMSE scores in observation group at 4 day and 3 month after surgery were （26.5±1.5）,（27.6±1.6）,which were significantly higher than those in control group [（24.3±1.3）,（25.8±1.5）],and the differences were statistically significant （P〈0.05）.But there were no significant differences in MMSE scores at 1 year after surgery between two groups （P〉0.05）.Conclusions Dex could improve cerebral oxygen metabolism and postoperative cognitive function during cardiopulmonary bypass of pediatric CHD surgery.
出处
《国际麻醉学与复苏杂志》
CAS
2017年第6期493-497,505,共6页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪定
体外循环
氧代谢
认知功能
Dexmedetomidine
Cardiopulmonary bypass
Oxygen metabolism
Cognitive function
作者简介
通信作者：韦天全，Email：weitianquan2@163．com
