盐酸右美托咪定联合右上臂缺血预处理对瓣膜置换术患者心肌保护及术后认知功能的影响  

Effects of dexmedetomidine hydrochloride combined with right upper limb ischemic preconditioning on myocardial protection and postoperative cognitive function in patients undergoing valve replacement

作　　者：吴亚辉 王韬甫 王保才 夏东升 林洪启 Wu Yahui;Wang Taofu;Wang Baocai;Xia Dongsheng;Lin Hongqi(Fuwai Huazhong Cardiovascular Hospital Heart Center,Henan Provincial People’s Hospital,Zhengzhou 450000,China;Fuwai Huazhong Cardiovascular Hospital,Henan Provincial People’s Hospital Cardiac Center Adult Cardiac Surgery,Zhengzhou 450000,China)

机构地区：[1]阜外华中心血管病医院河南省人民医院心脏中心,郑州450000 [2]阜外华中心血管病医院河南省人民医院心脏中心成人心脏外科,郑州450000

出　　处：《中华实验外科杂志》2023年第12期2618-2622,共5页Chinese Journal of Experimental Surgery

基　　金：2021年河南省联合共建项目(LHGJ20210104)。

摘　　要：目的探讨盐酸右美托咪定(DEX)联合远端缺血预处理(RIPC)对心脏瓣膜置换术患者心肌损伤及术后认知功能的影响。方法选取2022年5月至2023年5月阜外华中心血管病医院收治的80例行瓣膜置换术的患者作为研究对象,采用随机数字表法将所有患者分为C组、D组、R组和DR组,每组患者各20例。在麻醉过程中,D组于阻断主动脉前静脉持续泵入盐酸右美托咪啶0.4μg/kg;R组在阻断主动脉前行右上臂缺血预处理,重复3次。DR组同时采用以上两种方法进行处理,C组无需进行任何处理。采用人心肌肌钙蛋白Ⅰ(cTn-Ⅰ)、人心肌肌钙蛋白T(cTn-T)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)酶联免疫吸附法(ELISA)试剂盒测定患者血清cTn-T、cTn-Ⅰ、IL-6、TNF-α水平。采用易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评价患者术后认知功能状况。采用谵妄评定量表(CAM)-98修订版评估患者术后谵妄的发生情况。采用15项恢复质量量表(QOR-15)评价患者术后恢复情况。结果DR组T2、T3、T4各时间点的血清cTn-T水平[(695.01±20.52)、(605.14±20.06)、(570.75±20.50)pg/ml]明显低于C组[(838.81±26.61)、(813.15±26.08)、(761.60±30.99)pg/ml]、D组[(735.53±20.28)、(693.44±26.87)、(653.29±21.48)pg/ml]和R组[(723.48±25.76)、(704.11±21.26)、(666.52±20.12)pg/ml,t=18.65、6.12、3.77、27.56、11.48、14.76、22.39、12.12、14.53,P<0.05]。DR组T2、T3、T4各时间点的血清cTn-Ⅰ水平[(11.40±0.89)、(7.53±0.64)、(4.85±0.38)ng/ml]明显低于C组[(13.94±1.30)、(10.46±0.77)、(7.27±0.54)ng/ml]、D组[(12.65±1.06)、(9.13±0.91)、(5.84±0.52)ng/ml]和R组[(12.95±1.20)、(9.15±0.82)、(5.99±0.57)ng/ml,t=6.97、3.92、4.52、12.77、6.29、6.78、16.00、6.71、7.24,P<0.05]。DR组T2、T3、T4各时间点的血清IL-6水平[(95.35±5.76)、(82.52±4.29)、(74.35±3.93)pg/ml]明显低于C组[(115.28±9.58)、(108.69±8.14)、(93.65±5.38)pg/ml]、D组[(102.03±3.55)�Objective To investigate the effects of dexmedetomidine(DEX)combined with remote ischemic preconditioning(RIPC)on myocardial injury and postoperative cognitive function in patients undergoing heart valve replacement.Methods 80 patients who underwent valve replacement surgery in Fuwai Huazhong Cardiovascular Hospital from May 2022 to May 2023 were selected as the research subjects.All patients were divided into C group,D group,R group,and DR group using a random number table method,with 20 patients in each group.During the anesthesia process,group D continued to pump 0.4μg/kg of dexmedetomidine hydrochloride before aortic occlusion;Group R underwent ischemic preconditioning in the right upper arm before aortic occlusion,repeated 3 times.The DR group was treated using both methods simultaneously,while the C group did not require any treatment.Using human cardiac troponinⅠ(cTn-Ⅰ),cardiac troponin T(cTn-T),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)text kit for the determination of serum cTn-T,cTn-Ⅰ,IL-6,and TNF-α.The postoperative cognitive function of patients was evaluated using the mini-mental state examination(MMSE)and the montreal cognitive assessment(MoCA).the confusion assessment method(CAM)-98 revised version was used to assess the incidence of postoperative delirium in patients.Evaluate the postoperative recovery of patients using the quality-of-recovery 15(QOR-15).Results The serum cTn-T levels in the DR group[(695.01±20.52),(605.14±20.06),(570.75±20.50)pg/ml]were significantly lower than those in the C group[(838.81±26.61),(813.15±26.08),(761.60±30.99)pg/ml],D group[(735.53±20.28),(693.44±26.87),(653.29±21.48)pg/ml]and R group[(723.48±25.76),(704.11±21.26),(666.52±20.12)pg/ml]at time points T2,T3,and T4(t=18.65,6.12,3.77,27.56,11.48,14.76,22.39,12.12,14.53,P<0.05).The serum cTn-Ⅰlevels in the DR group[(11.40±0.89),(7.53±0.64),(4.85±0.38)ng/ml]were significantly lower than those in the C group[(13.94±1.30),(10.46±0.77),(7.27±0.54)ng/ml],D group[(12.65±1.06),(9.13±

关 键 词：右美托咪定 远端缺血预处理 瓣膜置换术 心肌保护 认知功能 

分 类 号：R614[医药卫生—麻醉学]