右美托咪定对体外循环下老年冠状动脉旁路移植术患者术后认知功能的影响  

Effect of dexmedetomidine on cognitive function in elderly patients after coronary artery bypass grafting under extracorporeal circulation

作　　者：王鹤昕 王洪武[2] Wang Hexin;Wang Hongwu(Chengde Medical College,Chengde 067QQQ,Hebei Province,China)

机构地区：[1]承德医学院,067000 [2]泰达国际心血管病医院麻醉科

出　　处：《中华老年心脑血管病杂志》2018年第11期1164-1168,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨右美托咪定对体外循环下老年冠状动脉旁路移植术(CABG)患者术后认知功能的影响。方法选择体外循环下择期行CABG的老年患者88例,采用随机数字表法分为对照组29例,低剂量右美托咪定组(低剂量组)30例和高剂量右美托咪定组(高剂量组)29例。分别记录诱导后(T0),锯开胸骨时(T1),停机后(T2),术毕(T3)的心率、平均动脉压、中心静脉压,并在T0和T2时检测白细胞介素(IL)-6、IL-8、S100β蛋白及神经元特异性烯醇化酶(NSE)水平;于术后1d(T4)、术后2d(T5)检测NSE、S100β蛋白;于术前1d,术后1、3d行蒙特利尔认知评估量表(MoCA)评分。结果高剂量组T1,T2,T3时心率明显低于对照组和低剂量组,且低剂量组T1,T2,T3时心率明显低于对照组(P<0.05)。3组T2时IL-6、IL-8、S100-β蛋白和NSE水平较T0时明显增加,T4和T5时S100-β蛋白和NSE水平较T2时明显减少,并在T5时进一步减少(P<0.05)。与对照组比较,低剂量组和高剂量组T2,T4,T5时IL-6、IL-8、S100-β蛋白和NSE水平明显降低,高剂量组更明显(P<0.05)。与低剂量组比较,高剂量组术后1dMoCA评分更高[(24.7±1.5)分vs(23.6±1.3)分,P<0.05]。结论右美托咪定对体外循环下老年CABG患者可以发挥神经系统的保护作用,减少术后认知功能障碍发生。Objective To study the effect of dexmedetomidine on cognitive function in elderly patients after CABG under extracorporeal circulation.Methods Eighty-eight elderly patients after CABG were divided into control group(n=29),low dexmedetomidine dose group(n=30)and high dexmedetomidine dose group(n=29).Their HR,MAP and CVP were measured at T0,T1 and T2 respectively,their serum levels of IL-6,IL-8,S-100βptotein and NSE were measured at T0 and T2 respectively,their serum S-100βprotein and NSE levels were measured at T4 and T5 respectively on days 1 and 2 after CABG,their MoCA scores were recorded on day 1 before CABG and on days 1 and 3 after CABG.Results The HR was significantly lower in high dexmedetomidine dose group than in control group and low dexmedetomidine dose group at T1,T2 and T3(P<0.05)and in low dexmedetomidine dose group than in control group(P<0.05).The serum levels of IL-6,IL-8,S100βprotein and NSE were significantly higher in 3 groups at T2 than at T0 while those of S100βprotein and NSE were significantly lower in 3 groups at T4 and T5,especially at T5 than at T2(P<0.05).The serum levels of IL-6,IL-8,S100βprotein and NSE were significantly lower in low and high dexmedetomidine dose groups,especially in high dexmedetomidine dose group than in control group at T2,T4,and T5(P<0.05).The MoCA score was higher in high dexmedetomidine dose group than in low dexmedetomidine dose group on day 1 after CABG(P<0.05).Conclusion Dexmedetomidine can protect the nervous system and reduce the occurrence of cognitive impairment in elderly patients after CABG under extracorporeal circulation.

关 键 词：右美托咪啶 心肺转流术 白细胞介素6 白细胞介素8 

分 类 号：R614[医药卫生—麻醉学]