摘要
目的患者体外循环后机体过度应激反应是发生肺部并发症的主要原因之一,有效减轻过度氧化应激反应能减少肺部并发症,帮助患者恢复。文中旨在探讨右美托咪定对先天性心脏病患儿体外循环后氧化应激反应及肺功能的影响。方法收集2016年6月至2018年6月遵义医科大学第一附属医院麻醉科在体外循环心脏直视下行先天性室间隔缺损或先天性房间隔缺损修补术的47例患儿。随机分为右美托咪定组(在小儿插管后,以0.5μg/kg·h泵注右美托咪定至手术结束,n=25)、对照组(泵注相同容量0.9%的等渗盐水,n=22)。分别在输注右美托咪定前、开胸时、CPB停机时、术后24 h,记录术中心率、平均动脉压等,根据血气分析计算呼吸指数及氧合指数,测血浆超氧化物歧化酶、丙二醛、血浆谷胱甘肽,随访术毕至拔除气管导管时间、术后在ICU的停留时间、肺部并发症情况。结果2组开胸时平均动脉压较给药前上升,停机时、术后24 h平均动脉压较开胸时下降(P<0.05)。右美托咪定组开胸时、停机时、术后24 h心率较对照组下降(P<0.05)。右美托咪定组CPB停机时、术后24 h血浆超氧化物歧化酶较给药前、开胸时升高(P<0.05)。右美托咪定组CPB停机时氧合指数[(416.00±31.89)mmHg]较对照组[(400.45±28.20)mmHg]明显上升(P<0.05),术后24 h呼吸指数[(0.30±0.10)mmHg]较对照组[(0.38±0.15)mmHg]下降(P<0.05)。右美托咪定组患儿的ICU支持时间、拔管时间较对照组明显缩短,术后肺部并发症发生率较对照组明显降低(28%vs 45.45%,P<0.05)。结论右美托咪定能改善患儿体外循环后的呼吸功能,降低术后的肺部并发症,有利于患儿术后的康复,但不能减轻体外循环患儿的氧化应激反应。
Objective To evaluate the effect of dexmedetomidine on oxidative stress and pulmonary function in children with Methods From June 2016 to June 2018,fifty-five children who underwent ven-tricular septal or atrial defect repair under cardiopulmonary bypass in the First Affiliated Hospital of Zunyi Medical University were recruit-ed and randomly divided into two groups:control group(group C)and dexmedetomidine group(group D).After tracheal intubation,pa-tients of group D were received dexmedetomidine 0.5 ug/kg/h by intra-venous pump until the end of operation.Patients of group C were re-ceived 0.9%physiological saline with the same volume.Heart rate,mean arterial pressure,oxygen saturation,bypass time,and com-putation of respiratory index(RI)and oxygenation index(OI)based on blood gas analysis,measured SOD,MDA and GSH in plas-ma,recording the time from the end of operation to the extubation of tracheal tube,the duration of stay in extracardiac ICU after opera-tion,and pulmonary complications were followed up before infusion of dexmedetomidine(T0),sternal sawing(T1),CPB stopping(T2),and 24 hours after operation(T3).Results The changes of heart rate and mean arterial pressure in the two groups were with-in the normal range.There was no significant difference in plasma SOD,MDA and GSH between the two groups(P>0.05).There was no difference in OI and RI at T0 and T1 time points(P>0.05).Compared with group C,OI was increased and RI was decreased in group D at T2 and T3 time points(P<0.05).Compared with group C,group D had shorter ICU support time and extubation time,and fewer pulmonary complications after operation(P<0.05).Conclusion The treatment of 0.5μg/kg/h dexmedetomidine can improve the respiratory function,reduce the pulmonary complications,and is conducive to the rehabilitation of children after CPB.But,this concentration cannot alleviate the oxidative stress reaction of children with CPB.
作者
郭宇含
张钰弦
韩明
陈松
蔡回钧
张红
GUO Yu-han;ZHANG Yu-xian;HAN Ming;CHEN Song;CAI Hui-jun;ZHANG Hong(Department of Anesthesiology,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)
出处
《医学研究生学报》
CAS
北大核心
2019年第12期1291-1295,共5页
Journal of Medical Postgraduates
基金
贵州省科技计划课题(黔科合SY字[2015]3050号)
贵州省麻醉学研究生工作站建设项目(黔教研合GZZ字[2016]05)
关键词
右美托咪定
氧化应激
体外循环
肺功能
dexmedetomidine
oxidative stress
cardiopulmonary bypass
lung function
