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右美托咪定对体外循环心脏瓣膜置换术患者心肌损伤及术后认知功能的影响
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| 篇名： | 右美托咪定对体外循环心脏瓣膜置换术患者心肌损伤及术后认知功能的影响 |
| TITLE： | |
| 摘要： | 目的：探讨右美托咪定对体外循环（CPB）心脏瓣膜置换术患者心肌损伤及术后认知功能的影响。方法： 选择我院2015年1月－2017年12月择期行CPB心脏瓣膜置换术的患者90例为研究对象，按随机数字表法分为C组和D组，各45例。D组患者在麻醉诱导完成后给予盐酸右美托咪定注射液负荷剂量0.6 μg/kg，后以0.6 μg/（kg·h）静脉输注至术毕；C组患者给予等容量和等速率的0.9％氯化钠注射液。观察两组患者用药前即刻（T0）、用药后即刻（T1）、切皮后即刻（T2）、劈胸骨后即刻（T3）、CPB前即刻（T4）、CPB停止即刻（T5）及术毕（T6）时的收缩压（SBP）、舒张压（DBP）、心率（HR）及平均动脉压（MAP）， T0、T5、T6、术后6 h（T7）、术后24 h（T8）时的肌酸激酶同工酶（CK-MB）、心型脂肪酸结合蛋白（H-FABP）、肌钙蛋白Ⅰ（cTnⅠ）， T0、T8、术后72 h（T9）时的S-100β蛋白及神经元特异性烯醇化酶（NSE）水平，术前1 d及术后3、7 d的简易智能量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分，术中心血管活性药物使用及不良反应发生情况。结果：C组患者T2～T6时SBP、DBP及D组患者T4～T6时SBP、T4时DBP均显著低于同组T0时，但D组患者T4～T6时SBP、DBP显著高于C组；两组患者T4时HR均显著低于同组T0时， T5～T6时均显著高于同组T0时，且D组T2～T3时显著低于C组；两组患者T2～T3时MAP均显著高于同组T0时，且D组T4时显著高于C组，差异均有统计学意义（P＜0.05）。T5～T8时，两组患者CK-MB、H-FABP和cTnⅠ水平均显著高于同组T0时，但D组患者T7～T8时CK-MB、cTnⅠ水平及T5～T8时H-FABP水平显著低于C组，差异均有统计学意义（P＜0.05）。T8～T9时，两组患者S-100β蛋白、NSE水平均显著高于同组T0时，但D组显著低于C组，差异均有统计学意义（P＜0.05）。两组患者术后3 d的MMSE评分、MoCA评分及C组患者术后7 d的MMSE评分、MoCA评分均显著低于同组术前1 d，但D组术后3 、7 d的评分均显著高于C组，差异均有统计学意义（P＜0.05）。D组患者多巴胺、去甲肾上腺素用量及肾上腺素使用率均显著低于C组，差异均有统计学意义（P＜0.05）；但两组患者米力农用量比较，差异无统计学意义（P＞0.05）。D组患者不良反应发生率（6.7％）显著低于C组（24.4％），差异有统计学意义（P＜0.05）。结论：右美托咪定有助于维持CPB心脏瓣膜置换术患者血流动力学稳定，减轻其心肌损伤，改善术后认知功能障碍，且安全性较高。 |
| ABSTRACT： | OBJECTIVE： To investigate the effects of dexmedetomidine on myocardial injury and postoperative cognitive function in patients with cardiopulmonary bypass （CPB） valve replacement. METHODS： A total of 90 patients underwent elective CPB valve replacement in our hospital during Jan. 2015-Dec. 2017 were divided into group C and group D according to random number table， with 45 cases in each group. Group D was given Dexmedetomidine hydrochloride injection 0.6 μg/kg after anesthesia induction and intravenous injection at 0.6 μg/（kg·h） to the end of the operation； group C was given 0.9％ Sodium chloride injection at equal volume and rate. SBP， DBP， HR and MAP were observed in 2 groups immediately before medication （T0）， immediately after medication （T1）， immediately after incision （T2）， immediately after sternotomy （T3）， immediately before CPB （T4）， immediately after CPB stopping （T5） and immediately after operation （T6）， respectively. The levels of CK-MB， H-FABP and cTnⅠ were observed at T0， T5， T6， at 6 h （T7） and 24 h （T8） after operation. The levels of S-100β protein and NSE were observed at T0， T8 and 72 h after operation （T9）. MMSE and MoCA scores were observed 1 d before operation and 3， 7 d after operation. The application of cardiovascular active drugs and the occurrence of ADR were observed during operation. RESULTS： SBP and DBP of group C at T2-T6， SBP at T4-T6 and DBP at T4 of group D were significantly lower than at T0； SBP and DBP of group D were significantly higher than group C at T4-T6. HR of 2 groups at T4 were significantly lower than at T0， while those of 2 groups at T5-T6 were significantly higher than at T0； the group D were significantly lower than group C at T2-T3. MAP of 2 groups at T2-T3 were significantly higher than at T0， and those of group D were significantly higher than group C at T4， with statistical significance （P＜0.05）. At T5-T8， the levels of CK-MB， H-FABP and cTnⅠ in 2 groups were significantly higher than at T0； the levels of CK-MB and cTnⅠ at T7-T8， the level of H-FABP at T5-T8 in group D were significantly lower than group C， with statistical significance （P＜0.05）. At T8-T9， the levels of S-100β protein and NSE in 2 groups were significantly higher than at T0， but the group D was significantly lower than group C， with statistical significance （P＜0.05）. MMSE scores and MoCA scores of 2 groups 3 d after operation， MMSE score and MoCA score of group C 7 d after operation were significantly lower than 1 d before surgery； those of group D 3， 7 d after operation were significantly higher than group C， with statistical significance （P＜0.05）. The amount of dopamine and norepinephrine， the rate of adrenalin use in group D were significantly lower than group C， with statistical significance （P＜0.05）. There was no statistical significance in the amount of milrinone between 2 groups （P＞0.05）. The incidence of ADR in group D （6.7％） was significantly lower than group C（24.4％）， with statistical significance（P＜0.05）. CONCLUSIONS： Dexmedetomidine is helpful for hemodynamic stability， relieve myocardial damage， and improve postoperative cognitive dysfunction in patients with CPB valve replacement with good safety. |
| 期刊： | 2018年第29卷第10期 |
| 作者： | 吴雅娟，任建光，蔡迪盛，周志鹏 |
| AUTHORS： | WU Yajuan，REN Jianguang，CAI Disheng，ZHOU Zhipeng |
| 关键字： | 右美托咪定；体外循环；心脏瓣膜置换术；心肌损伤；认知功能 |
| KEYWORDS： | Dexmedetomidine； Cardiopulmonary bypass； Valve replacement； Myocardial injury； Cognitive function |
| 阅读数： | 259 次 |
| 本月下载数： | 3 次 |
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