右美托咪定对高原地区成年患者体外循环心内直视手术术后认知功能的影响  

The Effect of Dexmedetomidine on Postoperative Cognitive Function in Adult Patients Undergone Open Heart surgery CPB at High Altitude

作　　者：陈仲海[1] 李守兰[1] 梁燕[1] 张春雪 贾珍[1] Chen Zhonghai;Li Shoulan;Liang Yan;Zhang Chunxue;Jia Zhen(Department of Anesthesia,Affiliated Hospital of Qinghai University,810001)

机构地区：[1]青海大学附属医院麻醉科,810001

出　　处：《高原医学杂志》2021年第1期13-18,共6页Journal of High Altitude Medicine

基　　金：2015年青海省卫生计生科研指导性计划课题项目(编号:Y2015-10)。

摘　　要：目的:探讨右美托咪定对高原地区成年患者体外循环(CPB)心内直视手术术后认知功能的影响。方法:收集2016年6月—2019年6月我院择期全麻行CPB心内直视手术的成年患者60例,随机分为对照组和观察组各30例。观察组患者于麻醉诱导前静脉注射右美托咪定0.6μg/kg(15min),随后以0.2μg/(kg·h)速率输注至术毕。对照组给予等容量等时间生理盐水。于麻醉后手术前(T_(1))、CPB开始后30min(T_(2))、CPB结束后30min(T_(3))、术后6h(T_(4))、术后24h(T5)测定颈内静脉球部血清TNF-α、IL-6水平及S100β蛋白浓度。分别于术前1天、术后第3天、第7天对患者进行简易智力量表(MMSE)测验。结果:T_(2)~T5时,观察组血清TNF-α、IL-6水平及S100β蛋白浓度明显低于对照组(P<0.05)。与T_(1)时比较,T_(2)~T5时两组血清TNF-α、IL-6水平及S100β蛋白浓度均明显升高(P<0.05)。与术前1天比较,两组患者术后第3天、第7天MMSE评分均明显降低(P<0.05)。两组患者术后第3天、第7天MMSE评分比较,观察组明显高于对照组(P<0.05)。结论:右美托咪定能够提高CPB下行心内直视手术成年患者早期MMSE评分,其机制可能与抑制炎性反应以及S100β蛋白表达有关。右美托咪定在成年患者心血管手术中应用效果良好,控制应激反应的同时能够减轻术后认知功能障碍,具有很好的临床应用价值。Objective:The purpose of this study is to observe the effects of dexmedetomidine(DEX)on postoperative cognitive function in the adult who had been undergone open heart surgery with cardiopulmonary bypass(CPB).Methods:Sixty patients in our hospital from June 2016 to June 2019 scheduled for open heart surgery,were randomly divided into 2 groups(n=30 each).The observation group received DEX 0.6μg/kg intravenously over 15 min before induction of anesthesia,followed by infusion at 0.2μg/(kg·h)until the end of operation,while the control group received the equal volume equal time of normal saline.Jugular bulb blood was collected at 5 min before the beginning of operation(T_(1)),30 min after the beginning of cardiopulmonary bypass(CPB)(T_(2)),30 minutes after the end of CPB(T_(3)),6h after the end of surgery(T_(4)),and 24h after the end of surgery(T5)to detect the serum levels of tumor necrosis factor(TNF-α),interleukin-6(IL-6)and S100βprotein.The cognitive function was evaluated in the light of MMSE 1 day before surgery,1 day after surgery,3 days after surgery and 7 days after surgery.Results:There was no significant difference in the adult serum level of TNF-α,IL-6 and S100βbetween the two groups at T_(1).The serum levels of TNF-α,IL-6 and S100βin observation group at T_(2)~T5 were lower than those in control group(P<0.05).The serum levels of TNF-α,IL-6 and S100βwere higher at T_(2)~T5 than at T_(1)in these two groups(P<0.05).Compared with T_(1),the serum level of S100βincreased obviously at T_(2),which reached a peak at T_(3),and then gradually declined.There was no difference of MMSE value between the two groups before operation.The MMSE values in two groups at 3 and 7 days after surgery were significantly lower than that before anesthesia(P<0.05).The MMSE values in observation group at 3 and 7 days after operation were significantly higher than that in control group(P<0.05).Conclusion:Dexmedetomidine could improve the early MMSE score of adult patients undergone the open heart surgery under CPB,and its

关 键 词：右美托咪定 术后认知功能障碍 心内直视手术 S100Β蛋白 炎性反应 

分 类 号：R614.24[医药卫生—麻醉学] R654.1[医药卫生—外科学]