右美托咪定联合乌司他丁对心肺转流下瓣膜置换术病人的脑保护作用  

Brain protective effect of dexmetomidine combined with ulinastatin on patients undergoing valve replacement under cardiopulmonary bypass

作　　者：殷凤伟 欧毅 王南海 刘刚 YIN Fengwei;OU Yi;WANG Nanhai;LIU Gang(Department of Anesthesiology,The First Affiliated Hospital of Bengbu Medical University,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医科大学第一附属医院麻醉科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2024年第2期175-181,共7页Journal of Bengbu Medical College

基　　金：蚌埠医学院科技发展基金项目(BYKF18100);蚌埠医学院自然科学研究重点项目(BYKY2019105ZD)。

摘　　要：目的:研究右美托咪定联合乌司他丁对心肺转流下瓣膜置换术病人的脑保护作用。方法:择期行心脏瓣膜置换术的病人80例,随机分为对照(N)组、右美托咪定(D)组、乌司他丁(U)组、右美托咪定复合乌司他丁(U+D)组。D组病人诱导前予以1.0μg/kg右美托咪定静脉泵入15 min,之后以0.4μg·kg^(-1)·h^(-1)持续输注至术毕,U组诱导后给予乌司他丁20000 U/kg,D+U组右美托咪定和乌司他丁使用方法同上,N组等量0.9%氯化钠溶液。在4组病人体外循环前(T_(1))、升主动脉开放(T_(2))、停机(T_(3))、术毕6 h(T_(4))行血气分析检测颈内静脉血氧饱和度(SjvO_(2))、动脉-颈内静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2)),并记录局部脑氧饱和度(rSO_(2)),同时于T_(1)~T_(4)、术毕24 h(T_(5))时间点采用ELISA法测定血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、S-100β蛋白、神经元特异性烯醇化酶(NSE)含量。最后于术前1 d(T_(0))、术后第7天(T 6)评定术后神经认知,统计术后1周内谵妄的发生情况。结果:T_(2)~T_(3)时,与N组相比,D组、U组、D+U组的SjvO_(2)明显升高,Da-jvO_(2)、CERO_(2)明显降低;与D组、U组相比,D+U组的SjvO_(2)明显升高,而Da-jvO_(2)、CERO_(2)明显降低(P<0.05~P<0.01)。T_(2)时,与N组相比,D组、U组、D+U组的rSO_(2)明显升高;与D组、U组相比,D+U组的rSO_(2)明显升高(P<0.05~P<0.01)。T_(2)~T_(4)时,与N组相比,D组、U组、D+U组的NSE、S-100β、IL-6、TNF-α水平显著降低;与D组、U组相比,D+U组的NSE、S-100β、IL-6、TNF-α水平显著降低(P<0.05~P<0.01)。T 6时,与N组相比,D组、U组、D+U组MMSE评分增高;与D组相比,D+U组MMSE评分增高(P<0.01),与U组相比,D+U组MMSE评分增高,差异有统计学意义(P<0.01)。T 6时,与N组相比,D组和U组谵妄发生率差异无统计学意义,而D+U组术后1周内谵妄发生率降低(P<0.01);与D组相比,D+U组谵妄发生率降低(P<0.05)。结论:右美托咪定联合乌司他丁可�Objective:To investigate the brain protective effect of dexmedetomidine combined with ulinastatin on patients undergoing valve replacement under cardiopulmonary bypass.Methods:Eighty patients undergoing elective cardiac valve replacement were randomly divided into control group(group N),dexmedetomidine group(group D),ulinastatin group(group U),and dexmedetomidine combined with ulinastatin group(group U+D).Group D was pumped 1.0μg/kg for 15 minutes before induction,and then 0.4μg·kg^(-1)·h^(-1) until the end of the operation.Group U was given 20000 U/kg intravenously immediately after induction.The usage of dexmetomidine and ulinastatin in group U+D was the same as above,and group N had the same amount of 0.9%sodium chloride solution.Before cardiopulmonary bypass(T_(1)),ascending aorta opening(T_(2)),shutdown(T_(3)),and 6 hours after surgery(T_(4)),blood gas analysis was performed to detect internal jugular vein oxygen saturation(SjvO_(2)),arterial internal jugular vein oxygen content difference(Da-jvO_(2)),and cerebral oxygen uptake rate(CERO_(2))in four groups of patients,and local cerebral oxygen saturation(rSO_(2))was recorded.Serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),S-100β,and neuron specific enolase(NSE)were measured by ELISA at the time point T_(1) to T_(4) and 24 hours after surgery(T_(5)).Finally,postoperative neurocognition was assessed on the first day before surgery(T_(0))and the seventh day after surgery(T 6),and the incidence of delirium within one week after surgery was statistically analyzed.Results:At T_(2)-T_(3),compared with group N,the levels of SjvO_(2) were remarkably raised in other three groups,while the leves of Da-jvO_(2) and CERO_(2) were remarkably descend;compared with group D and group U,the levels of SjvO_(2) were remarkably raised in group D+U,while the levels of Da-jvO_(2) and CERO_(2) was remarkably descend(P<0.05 to P<0.01).At T_(2),compared with group N,the levels of rSO_(2) was remarkably raised in other three groups;compared with group D and group U,the

关 键 词：心肺转流 瓣膜置换术 右美托咪定 乌司他丁 脑保护 

分 类 号：R614.27[医药卫生—麻醉学]