摘要
目的 探讨右美托咪定对心肺转流(cardiopulmonary bypass,CPB)心脏瓣膜置换术患者术后认知功能及脑氧代谢功能的影响。方法 选择2021年1月—2023年6月本院收治的CPB心脏瓣膜置换术患者72例作为研究对象,依据随机数表法分为对照组和观察组两组,每组各36例。对照组给予等速等量生理盐水,观察组患者给予右美托咪定。两组均术后观察7 d。比较两组平均动脉压(MAP)、心率(HR)、收缩压(SBP)、舒张压(DBP)、人高迁移率族蛋白1(HMGB-1)、心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)、肺泡动脉氧分压差(AaDO_(2))、氧合指数(OI)、静脉血氧饱和度(SjvO_(2))、动脉-静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)、不良反应。结果 与术前比,术毕两组MAP、SBP、DBP、Da-jvO_(2)、CERO_(2)水平均降低,且观察组低于对照组;术毕两组HR、SjvO_(2)升高,且观察组高于对照组;术后24 h两组HMGB-1、H-FABP、cTnI、CK-MB、AaDO_(2)水平均升高,观察组均低于对照组(P<0.05);术后24 h两组OI水平均降低,观察组高于对照组(P<0.05);术后3~7 d两组MMSE、MoCA评分为先降低后升高的趋势,观察组均高于对照组(P<0.05);术后24 h两组TNF-α、IL-6、IL-1β水平均升高,观察组均低于对照组(P<0.05);术后观察组不良反应总发生率低于对照组(P<0.05)。结论 CPB心脏瓣膜置换术下,应用右美托咪定可以稳定患者机体血流动力学,减轻其心肌损伤,促进脑能量代谢及脑组织氧供需平衡,改善术后认知功能障碍,抑制血清炎性因子水平,且可降低不良反应发生风险。
Objective To investigate the impact of dexmedetomidine on postoperative cognitive function and cerebral oxygen metabolism function in patients undergoing cardiopulmonary bypass (CPB) heart valve replacement.Methods 72 patients who were admitted to our hospital and received CPB heart valve replacement from January 2021 to June 2023 were enrolled as study subjects,and they were divided into the control group (36cases) and the observation group (36 cases) according to the random number table method.The control group was given isokinetic saline,and the observation group was given dexmedetomidine.Both groups were observed for 7days after operation.The mean arterial pressure (MAP),heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),human high mobility group protein-1 (HMGB-1),heart fatty acid binding protein (H-FABP),cardiac troponin I (cTnI),creatine kinase isoenzyme MB (CK-MB),alveolar arterial oxygen partial pressure difference (Aa DO_(2)),oxygenation index (OI),venous blood oxygen saturation (SjvO_(2)),arterial-venous blood oxygen content difference (Da-jvO_(2)),cerebral oxygen uptake rate (CERO_(2)),mini-mental state examination (MMSE),Montreal cognitive assessment scale (MoCA) score,tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),interleukin-1β (IL-1β) and adverse reactions were compared between the two groups.Results Compared with before operation,the levels of MAP,SBP,DBP,Da-jvO_(2),and CERO_(2of) the both groups decreased after operation,and those of the observation group was lower than the control group.After operation,HR,Sjv O_(2of) the two groups increased,and the observation group was higher than that in the control group.At 24 h after operation,the levels of HMGB-1,H-FABP,c Tn I,CK-MB and Aa DO_(2of) the two groups all increased,those of the observation group were lower than the control group (P<0.05).OI levels of the both groups decreased at 24 h after operation,and those of the observation group was higher than the control group (P<0.05).MMSE and MoCA scores of the two groups decreased at first and then increased at 3 to 7 d after operation,and the observation group was higher than the control group (P<0.05).The levels of TNF-α,IL-6and IL-1β of the both groups increased at 24 h after operation,the observation group was lower than the control group (P<0.05).The total incidence of adverse reactions of the observation group was lower than that of the control group (P<0.05).Conclusions Dexmedetomidine can stabilize the hemodynamics of patients under CPB heart valve replacement.It can alleviate myocardial injury,promote brain energy metabolism and balance of oxygen supply and demand in brain tissue,improve postoperative cognitive dysfunction,inhibit serum inflammatory factors,and reduce the risk of adverse reactions.
作者
李培志
曲俊星
陈胜阳
王凯
孙志恒
Li Peizhi;Qu Junxing;Chen Shengyang;Wang Kai;Sun Zhiheng(Department of Anesthesiology,the First People's Hospital of Xinxiang City(the Fifth Clinical School of Xinxiang Medical University),Xinxiang,Henan 453000,China;Health Central Plains Research Institute,Xinxiang Medical University,Xinxiang,Henan 453000,China;Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang,Henan 453000,China;Department of Anesthesiology and Perioperative Medicine,Xinxiang Central Hospital(the Fourth Clinical School of Xinxiang Medical University),Xinxiang,Henan 453000,China;School of life Sciences,Henan Normal University,Xinxiang,Henan 453000,China)
出处
《齐齐哈尔医学院学报》
2024年第4期330-335,共6页
Journal of Qiqihar Medical University
基金
2018年度河南省医学科技攻关计划项目(2018020351)。
关键词
右美托咪定
心肺转流
心脏瓣膜置换术
认知功能
脑氧代谢功能
Dexmedetomidine
Cardiopulmonary bypass
Heart valve replacement
Cognitive function
Cerebral oxygen metabolism function
