右美托咪啶对体外循环下瓣膜置换术后患者认知功能改变的影响  

Effects of dexmedetomidine on changes of cognitive function in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：朱永锋[1] 孟凡民[1] 

机构地区：[1]河南省人民医院麻醉科,郑州450003

出　　处：《中华胸心血管外科杂志》2014年第7期404-407,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨右美托咪啶（DEX）对体外循环（CPB）下心脏瓣膜置换术后患者认知功能改变的影响.方法 CPB下心脏瓣膜置换术患者60例,按数字表法随机分为右美托咪啶组（DEX组,n=30）和生理盐水组（NS组,n=30）.DEX组于麻醉诱导前给予DEX 0.5μg/kg,10 min内泵注完毕;后以0.5 μg＆#183;kg-1＆#183;h-1维持量继续泵注至手术结束.相同时间内,NS组予等量等速生理盐水,操作同DEX组.记录主动脉阻断时间、CPB时间、麻醉时间及CPB前10 min动脉血氧分压（PaO2）,观察麻醉诱导前（T0）、诱导后10 min（T1）、复温至36℃时（T2）、CPB停机后1 h（T3）、6 h（T4）、24 h（T5）、48 h（T6）、72 h（T7）时患者心率（HR）、平均动脉压（MAP）、颈静脉球部血氧饱和度（SJvO2）和血氧分压（PJvO2）,术后3天行简明精神状态量表（MMSE）评分,记录术后认知功能障碍（POCD）的发生比例.结果 两组患者的主动脉阻断时间、CPB时间、麻醉时间及CPB前10 min PaO2差异无统计学意义（P＞0.05）;与T0比较,NS组在T1～ T2、T4～T7时、DEX组在T1、T4～T7时的SJvO2、PJvO2下降（P＜0.05,P＜0.01）;与NS组比较,DEX组在T2～ T3时SJvO2、PJvO2升高（P＜0.01）;术后3天,DEX组的MMSE评分及POCD发生比例均低于NS组（P＜0.05,P＜0.叭）.结论 患者行体外循环下心脏瓣膜置换术后可能发生认知功能障碍,右美托咪啶可降低脑组织氧耗量,改善患者的认知功能障碍.Objective To explore the effects of dexmedetomidine（DEX） on the changes of patient＆#39; s cognitive function after undergoing cardiac valve replacement with cardiopulmonary bypass（CPB）.Methods Sixty patients to selectively receive cardiac valve replacement with CPB were randomly divided into two groups：DEX group（n =30） and normal saline group（NS group,n =30）.DEX （0.5 μ.g/kg bolus and infusion at a rate of 0.5 μg ＆#183; kg-1 ＆#183; h-1） was administered to the patients of DEX group,and the patients of NS group were given with equivalent normal saline at the same time.Aortic clamped time,CPB time,duration of anesthesia and PaO2 at 10 min before CPB were recorded.Heart rate（HR）,mean arterial pressure（MAP）,jugular venous oxygen saturation（SJvO2） and jugular venous oxygen partial pressure（PJvO2） of anesthesia induction（T0）,10 min after induction（T1）,CPB re-warmed to 36℃ （T2）,and 1 h（T3）,6 h（T4）,24 h （T5）,48 h （T6）,72 h （T7） after CPB were performed.MMSE were performed 3 days after surgery,the incidence of POCD was calculated.Results There was no statistical significance in aortic clamped time,duration of CPB,anesthesia time and PaO2 at 10 min before CPB （P 〉 0.05） between both of groups.Compared to TO,SJvO2 and PJvO2 of NS group from T1 to T2,T4 to T7 and DEX group at T1,T4 to T7 were decreased（P〈0.05,P〈0.01）.Compared to NS group,SJvO2 and PJvO2 of DEX group from T2 to T3 were increased（P 〈 0.01）.MMSE evaluation and the incidence of POCD of DEX group were better than those of NS group 3 days af ter surgery（P 〈0.05,P 〈 0.01）.Conclusion Cardiac valve replacement with CPB can lead to cognitive impairment in pa tients,dexmedetomidine can ameliorate cognitive function by decreasing oxygen consumption in brain tissue.

关 键 词：右美托咪啶 心肺转流术 认知功能障碍 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]