右美托咪定对体外循环法洛四联症矫正术患儿的脑保护效应  

Cerebral protective effect of dexmedetomidine in pediatric patients undergoing correction of tetralogy of Fallot with cardiopulmonary bypass

作　　者：郎志斌[1] 范晓珍[1] 张加强[1] 孟凡民[1] 

机构地区：[1]河南省人民医院麻醉科,郑州市450003

出　　处：《中华麻醉学杂志》2015年第5期525-528,共4页Chinese Journal of Anesthesiology

摘　　要：目的：评价右美托咪定对体外循环（ CPB）法洛四联症矫正术患儿的脑保护效应。方法择期CPB法洛四联症矫正术患儿60例，性别不限，年龄11个月～14岁，BMI 9．8～21．4 kg∕m2， ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将其分为2组（ n＝30）：生理盐水组（ NS组）和右美托咪定组（ Dex组）。 Dex组于常规麻醉诱导前经10 min静脉输注右美托咪定0．5μg∕kg，继之以0．5μg·kg-1·h-1的速率输注至术毕；NS组以等容量生理盐水替代。于麻醉诱导前（ T0）、麻醉诱导后10 min（ T1）、复温至36℃（ T2）、CPB停机1 h（ T3）、6 h（ T4）、24 h（ T5）、48 h（ T6）和72 h（ T7）时采集桡动脉和颈内静脉球部血样行血气分析，记录颈静脉球部血氧饱和度（ SjvO2）、颈静脉球部血氧分压（ PjvO2），计算脑氧摄取率（ CERO2）和脑动静脉血氧含量差（ Da-jvO2）；于T0、T3～T7时采用ELISA法检测血清S-100β蛋白和神经元特异性烯醇化酶（ NSE）浓度。记录机械通气时间、ICU停留时间及术后并发症的发生情况。结果与T0时比较，NS组和Dex组T3～7时血清S-100β蛋白和NSE浓度升高，T1～2时SjvO2和PjvO2升高、CERO2和Da-jvO2降低（ P＜0．01）。与NS组比较，Dex组T3～7时血清S-100β蛋白和NSE浓度降低（ P＜0．01），术后机械通气时间、ICU停留时间及窦性心动过缓、低血压、再次气管插管发生率比较差异无统计学意义（ P＞0．05）。2组脑氧代谢指标均在正常范围，组间比较差异无统计学意义（ P＞0．05）。结论常规麻醉诱导前静脉输注右美托咪定0．5μg∕kg，随后以0．5μg·kg－1·h－1输注至术毕对CPB法洛四联症矫正术患儿具有脑保护效应。Objective To evaluate the cerebral protective effect of dexmedetomidine in the pediatric patients undergoing correction of tetralogy of Fallot with cardiopulmonary bypass （ CPB） . Methods Sixty pediatric patients of both sexes, aged 11 months-14 yr, with body mass index of 9.8-21.4 kg∕m2 , of ASA physical status Ⅱ or Ⅲ, scheduled for elective correction of tetralogy of Fallot with CPB, were randomly divided into 2 groups （n=30 each） using a random number table： normal saline group （group NS） and dexmedetomidine group （group Dex）. Dexmedetomidine was infused intravenously at a dose of 0.5 μg∕kg over 10 min before induction of anesthesia, followed by 0.5μg·kg-1 ·h-1 infusion until the end of surgery. The equal volume of normal saline was given instead in group NS. Before induction of anesthesia （ baseline, T0 ） , and at 10 min after induction （ T1 ） , after re-warming to 36℃ （ T2 ） , and at 1, 6, 24, 48 and 72 h after termination of CPB （ T3-7 ） , blood samples were obtained from the radial artery and jugular venous bulb for blood gas analysis, jugular venous oxygen saturation （ SjvO2 ） and jugular venous oxygen partial pressure （ PjvO2 ） were recorded, and cerebral O2 extraction rate （ CERO2 ） and arteriovenous blood O2 content difference （ Da-jvO2 ） were calculated. The concentrations of S-100βprotein and neuron-specific enzyme （ NSE） in serum were determined by enzyme-linked immunosorbent assay at T0 and T3-7 . The time for mechanical ventilation, duration of intensive care unit stay, and development of postoperative complications were recorded. Results Compared with the baseline value at T0 , the serum concentrations of S-100β and NSE were significantly increased at T3-7 , and SjvO2 and PjvO2 were increased, and CERO2 and Da-jvO2 were decreased at T2 in both groups. Compared with group NS, the serum concentrations of S-100β and NSE were significantly decreased at T3-7 , and no significant changes were found in the time for mechanical ventila

关 键 词：右美托咪啶 法乐四联症 心肺转流术 脑 儿童 

分 类 号：R726.1[医药卫生—儿科]