右美托咪定对体外循环下心脏瓣膜置换术患者术后谵妄和炎症因子的影响  

Effects of dexmedetomidine on postoperative delirium and inflammatory factors in patients undergoing cardiac valve replacement under CPB

作　　者：梁冰 李玲[1] 吴玉龙 贾玲 王靠 陈康 陈宇 LIANG Bing;LI Ling;WU Yu-long;JIA Ling;WANG Que;CHEN Kang;CHEN Yu(Department of Anesthesiolog,Chongqing Hospital,Jiangsu Provincial Hospital,Chongqing 401420;Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]江苏省人民医院重庆医院麻醉科,重庆401420 [2]南京医科大学第一附属医院麻醉与围手术期医学科,江苏南京210029

出　　处：《川北医学院学报》2024年第5期633-636,共4页Journal of North Sichuan Medical College

基　　金：江苏省卫生健康发展中心2021年度开放课题(JSHD2021006)。

摘　　要：目的:探讨右美托咪定对心脏瓣膜置换术患者术后谵妄(POD)的预防作用及其可能机制。方法:将130例行心脏瓣膜置换术患者按照麻醉方式不同分为对照组与观察组,每组各65例。麻醉诱导后,观察组予以右美托咪定输注;对照组则予以等量生理盐水泵注。比较两组患者术后7 d内POD发生情况,于术前及术后24 h检测血清神经损伤标志物[神经元特异性烯醇化酶(NSE)、S100钙结合蛋白B(S100β)]和炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)],并比较术后一般情况和不良反应发生情况。结果:观察组患者拔管后5 min和30 min的RSAS评分低于对照组(P<0.05),拔管后30 min的VAS评分低于对照组(P<0.05);观察组患者POD发生率低于对照组(18.46%vs.36.92%,P<0.05),谵妄持续时间短于对照组(P<0.05);术后24 h,两组患者血清NSE、S100β和TNF-α、IL-6水平均升高,但观察组低于对照组(P<0.05);观察组患者术后舒芬太尼用量少于对照组(P<0.05),ICU停留时间短于对照组(P<0.05);两组术后48 h内不良反应发生率差异无统计学意义(P>0.05)。结论:右美托咪定输注降低心脏瓣膜置换术患者POD发生率,抑制炎症反应。Objective:To investigate the preventive effect of continuous infusion of dexmedetomidine on postoperative delirium(POD)in patients undergoing cardiac valve replacement and its possible mechanism.Methods:130 patients with cardiac valve replacement were divided into control group and observation group according to different anesthesia methods,with 65 cases in each group.After anesthesia induction,the observation group was given infusion of dexmedetomidine,and the control group was given the same amount of normal saline pumping.The occurrence of POD within 7 days after operation was compared between the two groups.Serum nerve injury markers[neuron-specific enolase(NSE),S100β]and inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]were detected before and 24 hours after operation,and the general condition and adverse reactions after operation were compared.Results:The RSAS scores at 5 and 30 minutes after extubation of the observation group were lower than those of the control group(P<0.05),and the VAS scores at 30 minutes after extubation were lower than those of the control group(P<0.05).Compared with the control group,the incidence of POD in the observation group was decreased(18.46%vs.36.92%,P<0.05),and the duration of delirium was shortened(P<0.05).At 24 h after operation,the levels of serum NSE,S100β,TNF-αand IL-6 in both groups increased,and the observation group was lower than the control group(P<0.05).Compared with the control group,the dosage of sufentanil in the observation group was reduced(P<0.05),and the ICU stay time was shortened(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups within 48 hours after operation(P>0.05).Conclusion:Dexmedetomidine infusion can reduce the incidence of POD in patients undergoing cardiac valve replacement,and inhibiting inflammatory response.

关 键 词：心脏瓣膜置换术 术后谵妄 右美托咪定 S100Β 炎症 

分 类 号：R614[医药卫生—麻醉学]