右美托咪定对不停跳冠脉旁路移植术患者术后认知功能的影响  

Effects of Dexmedetomidine on Postoperative Cognitive Function in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

作　　者：廖明锋[1] 杨辉[1] 陈欣[1] 赵以林[1] 杨柳[1] 罗爱林[1] 迟晓慧[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉430030

出　　处：《华中科技大学学报（医学版）》2015年第5期520-523,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的通过比较不同剂量右美托咪定对不停跳冠脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)患者术后认知功能的影响,探讨右美托咪定在OPCAB中的合理运用。方法选择96例择期行OPCAB的患者,随机分为对照组(C组)、低剂量右美托咪定组(L组)和高剂量右美托咪定组(H组),术中分别接受不同剂量的右美托咪定持续输注。于术前1d和术后7d对患者进行简易智力量表(MMSE)评分,术前、术后24h和48h测定血浆S100β和Aβ1-42水平。结果与术前相比,3组患者术后MMSE评分明显下降,但3组之间没有统计学差异(P>0.05);H组患者术后48h时S100β和Aβ1-42水平显著升高(均P<0.05)。结论术中持续输注高剂量右美托咪定会增加OPCAB患者术后血浆S100β和Aβ1-42水平,在OPCAB术中使用右美托咪定的剂量需要谨慎。Objective To investigate the appropriate use of dexmedetomidine in patients undergoing off-pump coronary artery bypass grafting（OPCAB）by comparing the effects of different concentrations of dexmedetomidine on patient＇s post-operative cognitive dysfunction（POCD）.Methods Ninety-six patients who underwent elective OPCAB were randomized into three groups：control group（group C）,low-dose dexmedetomidine group（group L）and high-dose dexmedetomidine group（group H）.In group L and group H,continual intravenous infusion of dexmedetomidine at different concentrations was given to patients during operation.Cognitive impairments were evaluated by using Mini-Mental State Examination（MMSE）scale 1dbefore and 7d after surgery.The blood samples were drawn to determine the serum S100β and Aβ1-42 levels before and 24 and 48hafter OPCAB.Results MMSE scores were declined significantly in all three groups 7dafter surgery when compared with those before surgery and there was no significant difference among these groups（P〈0.05）.The levels of S100βand Aβ1-42 were profoundly increased 48 hafter surgery in group H（P〈0.05）.Conclusion Continual intravenous infusion of dexmedetomidine at high dose can increase the serum levels of S100βand Aβ1-42,which suggests that anesthetists need to be cautious about using higher dose of dexmedotomidine during OPCAB.

关 键 词：右美托咪定 术后认知功能障碍 不停跳冠脉旁路移植术 S100Β AΒ1-42 

分 类 号：R614[医药卫生—麻醉学]