摘要
目的探讨右美托咪定对心脏瓣膜置换术患者的脑保护作用。方法选择择期行体外循环下心脏瓣膜置换术患者70例，按照随机数字表法分为对照组和观察组，每组35例。观察组患者在麻醉诱导前予以0．6μg·kg^-1右美托咪定静脉注射，注射时间控制在15min以内，之后继续进行输注直至术毕，输注速率为0．2μg·kg^-1·h^-1。对照组患者予以同观察组等量的生理盐水进行静脉注射和输注。对2组患者体外循环前（T1）、升主动脉开放（T2）、体外循环结束后10min（T3）、术后6h（T4）时的颈内静脉血氧饱和度（SjvO2）、动脉一颈内静脉血氧含量差（Da-jvO2）及脑氧摄取率（CERO2）进行监测分析，并对T1～T4及术后24h（T5）的血浆S-100β蛋白及神经元特异性烯醇化酶（NSE）进行检测。结果2组患者T2时SjvO2显著高于T1，而Da-jvO2、CERO2显著低于T1（P〈0．05），T2、T3、T4时S-100β蛋白及NSE水平显著高于T1（P〈0．05）；观察组患者T2、T3时SjvO2显著高于对照组，而Da-jvO2、CERO2显著低于对照组（P〈0．05）；观察组患者T2、L、T4时S-100β蛋白及NSE水平均显著低于对照组（P〈0．05）。结论右美托咪定应用于心脏瓣膜置换术中能显著改善患者的脑氧代谢情况，减少术中脑缺血缺氧状态，降低脑血管损伤发生的概率，具有脑保护作用。
Objective To explore the protective effect of dexmedetomidine on patients with cardiac valve replacement. Methods Seventy patients who received cardiac valve replacement under extracorporeal circulation were randomly divided in- to control group and observation group according to random digits table ,with 35 patients in each group. Patients in observation group were given intravenous injection of 0.6μg · kg ^- 1 dexmedetomidine before induction of anesthesia, injection time was within 15 min, then patients were given infusion until the end of operation, infusion rate was 0. 2 μg · kg^- 1 ·h^-1. Patients in control group were given the intravenous injection and infusion of the same mass of normal saline. Jugular venous oxygen satu- ration （ SjvO2 ） , arterial venous oxygen content difference（ Da-jvO2 ） and cerebral extraction of oxygen（ CERO2 ） were recorded before extracorporeal circulation （ Tl ）, when the ascending aorta was open （ T2 ）, 10 minutes after extracorporeal circulation （T3 ） , six hours after operation （T4 ）. The levels of plasma S-100β protein and neuron-specific enolase （NSE）were detected and analyzed at TI to T4 and 24 hours after operation （T5 ）. Results Comparison within groups, the level of SjvO2 at T2 was higher than that at T1, while Da-jvO2 and CERO2 were significantly lower than those at T1 （P 〈 0.05 ）, the levels of S-100β protein and NES of T2, T3 and T4 were significantly higher than those of T1 （ P 〈 0.05 ）. The level of SjvO2 in observation group at T2 and T3 was significantly higher than that in control group, while Da-jvO2 and CERO2 were significantly lower than those in control group（P 〈 0.05 ）. The levels of S-100β protein and NES in observation group were significantly lower than those in control group （P 〈 0.05）. Conclusion Dexmedetomidine can significantly improve the cerebral oxygen metabolism, reduce cerebral ischemia hypoxia in patients with cardiac valve replacement ,it can reduce the probability of cerebral vascular injury, so dexmedetomidine has cerebral protective effect to some certain extent.
出处
《新乡医学院学报》
CAS
2015年第8期762-765,共4页
Journal of Xinxiang Medical University
关键词
右美托咪定
心脏瓣膜置换术
体外循环
脑代谢
脑保护
dexmedetomidine
cardiac valve replacement
extracorporeal circulation
brain metabolism
brain protective
