右美托咪啶在心脏直视手术患者围体外循环期的应用效果  

Effects of dexmedetomidine during cardiopulmonary bypass in patients undergoing open heart surgery

作　　者：张佳雷 张晓玲 

机构地区：[1]山西省长治市人民医院麻醉科,046000 [2]山西省长治市人民医院肿瘤内科,046000

出　　处：《中国实用医刊》2016年第13期10-12,共3页Chinese Journal of Practical Medicine

摘　　要：目的：探讨右美托咪啶（ Dex）对心脏直视手术患者围体外循环期的应用效果。方法选择30例拟在体外循环（ CPB）下行心脏直视手术的先天性心脏病患者，随机分为两组，每组15例。右美托咪啶组（ Dex组）于患者手术开始前30 min给予负荷量1μg/kg（10 min内输完），后以0.5μg/（kg·h）剂量持续输注。对照组用等容量氯化钠注射液代替。分别于切皮前（T1）、CPB开始后30 min（T2）及CPB结束后30 min（T3）、4 h（T4）、24 h（T5）采集血样，测定血浆中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）和丙二醛（MDA）浓度及超氧化物歧化酶（SOD）活性。结果对照组TNF-α在T2~T5时间点分别为（34.3±4.4）、（44.2±7.1）、（50.1±7.9）、（35.2±9.0）pg/ml，均高于Dex组，差异有统计学意义（P﹤0.05），IL-10均低于Dex组（P﹤0.05）。两组MDA均于CPB开始后升高，且均与同组T1时比较差异有统计学意义（ P﹤0.05），Dex组在T2~T5时间点与对照组比较差异有统计学意义（ P﹤0.05）。两组SOD活性于CPB开始后降低，对照组T2~T5与T1时比较差异有统计学意义（P﹤0.05），Dex组T3~T4与T1时比较差异有统计学意义（P﹤0.05），且在T2~T4与对照组比较差异有统计学意义（ P﹤0.05）。结论右美托咪啶可抑制心脏手术CPB导致的全身性炎症反应，减少自由基生成，从而减轻心肌缺血再灌注损伤。Objective To investigate the efficacy of dexmedetomidine during cardiopulmonary bypass in patients underwent open heart surgery. Methods Thirty patients with congenital heart disease were selected and randomly divided into two groups,with 15 cases in each group. dexmedetomidine group（ Dex group）received loading dose 1 μg/kg at 30 minutes before the operation within 10 minutes, and continuous infusion at 0. 5 μg/（ kg·h）until the end of operation;control group received normal sa-line instead of dexmedetomidine. Blood samples were taken before skin incision（ T1 ）,30 minutes after start of CPB（ T2 ）and 30 min（ T3 ）,4 h（ T4 ）,24 h（ T5 ）after termination of CPB for determination of plasma TNF-α,IL-6,IL-10,MDA concentration and SOD activity. Results TNF-α in T2-T5 time of the control group was（ 34. 3 ± 4. 4 ）,（ 44. 2 ± 7. 1 ）,（ 50. 1 ± 7. 9 ）,（ 35. 2 ± 9. 0 ）pg/ml respectively, they were higher than that of the Dex group,the differences were significant（ P ﹤0.05 ）,IL-10 of the control group was lower than that of the Dex group（ P﹤0.05 ）. The plasma level of MDA increased after CPB in both groups and higher than the baseline values（ T1 ）,and the MDA of Dex group were lower than those in control group,the differences were significant（P﹤0.05）at T2-T5. SOD activity decreased after CPB in both groups and at T2-T4 in Dex group higher than that in control group,the differences were significant（ P﹤0.05 ）. Conclusions Dexmedetomidine is effective in reducing CPB induced inflammatory response and increase in oxygen free radicals.

关 键 词：体外循环 炎性反应 氧化应激 右美托咪啶 

分 类 号：R654.2[医药卫生—外科学]