右美托咪定对体外循环心脏瓣膜置换术患者术后认知功能障碍的影响  

Effect of dexmedetomidine on postoperative cognitive dysfunction in patients undergoing cardiac valve replacement with CPB

作　　者：何庆标[1] 黄威[1] 王育明[1] 孙振中[1] 詹长春[1] HE Qingbiao HUANG Wei WANG Yuming SUN Zhenzhong ZHAN Changchun(Department of Anesthesiology, Armed Police Hospital, Guangzhou 510507, China)

机构地区：[1]武警广东省总队医院麻醉科,广东广州510507

出　　处：《上海医药》2017年第5期18-20,24,共4页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的 :探讨右美托咪定(DEX)对体外循环(CPB)心脏瓣膜置换术患者术后认知功能障碍(POCD)的影响。方法 :选择择期CPB下心脏瓣膜置换术患者90例,采用随机数字表法分为DEX组和对照组各45例。DEX组患者麻醉诱导前给予DEX 0.5μg/kg负荷量,然后以0.5μg/(kg·h)速度持续输注至手术结束;对照组患者同样方式给予等量生理盐水。分别于麻醉诱导前(T0)、CPB开始后30 min(T1)、CPB结束(T2)、术毕(T3)、术后24 h(T4)和72 h(T5)时从颈静脉球部采集血液标本检测肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)水平;采用蒙特利尔认知评估表(Mo CA)评分于术前l d及术后3 d、7 d评估患者的认知功能。结果 :与T0比较,2组患者T1~T5时血浆TNF-α、IL-6水平均明显升高(P<0.05);与对照组比较,DEX组T1~T5时TNF-α、IL-6水平均明显降低(P<0.05);2组患者术后3 d、7 d Mo CA评分低于术前1 d(P<0.05),DEX组术后3 d、7 d Mo CA评分均高于对照组(P<0.05)。DEX组POCD发生率较对照组下降(P<0.05)。结论 :在麻醉诱导前给予DEX 0.5μg/kg负荷量及术中0.5μg/(kg·h)维持,可在一定程度上抑制CPB心脏瓣膜置换术患者中枢炎症反应,改善术后认知功能,降低POCD发生率。Objective： To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction （POCD） in patients undergoing cardiac valve replacement with CPB. Methods： Ninety patients were randomly divided into a control group and a DEX group with 45 cases each. DEX was administered to the patients in DEX group with a loading dose of 0.5 μg/kg before induction of anesthesia, followed by maintenance dose of 0.5 μg/（kg·h） while with the same dose of normal saline instead in the control group. Venous blood samples were collected from jugular bulb catheter before incision （TO）, at 30 min after beginning of CBP （T1）, the end of CBP （T2） and operation （T3）, and 24 h （T4）, 48 h （T5） after operation and serum concentrations of TNF-ct and IL-6 were determined. The cognitive function was evaluated by MoCA on one day before operation and the third and seventh days after operation. Results： The serum concentrations of TNF-α and IL-6 in two groups at T1-T5 were significantly higher than those at TO （P〈0.05） and were significantly lower in DEX group than in the control group （P〈0.05）. MoCA scores on the third and seventh days after operation were lower than one day before operation in both groups and were higher in the DEX group than in the control group （P〈0.05）. The incidence of POCD was lower in the DEX group than in the control group （P〈0.05）. Conclusion： DEX with a loading dose of 0.5 μg/kg followed by maintenance dose of 0.5 μg/（kg·h） can inhibit the central inflammatory response, improve POCD and reduce the incidence of POCD in cardiac surgery with CPB.

关 键 词：右美托咪定 体外循环 心脏瓣膜置换术 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]