摘要
目的探讨右美托咪啶对体外循环下瓣膜置换术后患者心肌和肺功能的影响。方法 2013年5月至2015年12月在新乡医学院第一附属医院行体外循环下二尖瓣置换术的70例患者为研究对象,采用随机数字表法分为观察组和对照组,每组35例,观察组患者接受右美托咪定联合常规静吸复合麻醉,对照组患者接受常规静吸复合麻醉。观察比较麻醉诱导前(T_1)、主动脉开放30 min(T_2)、术毕即刻(T_3)、术后6 h(T_4)、术后24 h(T_5)时2组患者的心肌损伤指标、肺功能指标以及氧化应激指标。结果 T_1时2组患者的血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)活性和心肌肌钙蛋白(cTnI)水平比较差异无统计学意义(P>0.05);2组患者T_2、T_3、T_4、T_5时的血清CK、CK-MB活性和cTnI水平均较T_1时显著增加(P<0.05);观察组患者T_2、T_3、T_4、T_5时的血清CK、CK-MB活性和cTnI水平均显著低于对照组(P<0.05)。T_1时2组患者的肺泡动脉氧分压差[P(A-a)O_2]、氧合指数(OI)、呼吸指数(RI)比较差异无统计学意义(P>0.05);T_2、T_3、T_4、T_5时点,2组患者的P(A-a)O_2、RI均显著高于麻醉诱导前(P<0.05),OI显著低于麻醉诱导前(P<0.05);观察组患者T_2、T_3、T_4、T_5时的P(A-a)O_2、RI均显著低于对照组(P<0.05),OI显著高于对照组(P<0.05)。T_1时2组患者的血清丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性差异无统计学意义(P>0.05);2组患者T_2、T_3、T_4、T_5时血清MDA含量较T_1显著升高(P<0.05),观察组患者的血清SOD活性较T_1显著升高(P<0.05),对照组患者的血清SOD活性与T_1时比较差异无统计学意义(P>0.05);观察组患者血清MDA含量在T_2、T_3、T_4、T_5时显著低于对照组(P<0.05),SOD活性在T_2、T_3、T_4、T_5各时点显著高于对照组(P<0.05)。结论右美托咪啶对体外循环下瓣膜置换术后患者的心功能和肺功能具有保护作用,同时能够减轻氧化应激反应。
Objective To investigate the effect of dexmedetomidine on myocardium and pulmonary function of patients underwent valve replacement under extracorporeal circulation.Methods A total of 70 patients underwent valve replacement under extracorporeal circulation were selected from May 2013 to December 2015 in the First Affiliated Hospital of Xinxiang Medical University.The patients were divided into observation group and control group by random number table method,35 patients in each group.The patients in the observation group received dexmedetomidine combined with intravenous and inhalation anesthesia,and the patients in the control group received combined intravenous and inhalation anesthesia.The indexes of myocardial damage,lung function and oxidative stress were observed and compared in the two groups at the time points of before induction of anesthesia （T1）,artery opening for 30 minutes （T2）,the end of operation （T3）,6 hours after operation （T4） and 24 hours after operation （T5）.Results There was no significant difference in the levels of serum creatine kinase （CK）,MB isoenzyme of creatine kinase （CK-MB） and cardiac troponin I（cTnI） between the two groups at T1 （P 〉0.05）.The levels of serum CK,CK-MB and cTnI at the time points of T2,T3,T4 and T5 were significantly higher than those at T1 in the two groups （P 〈 0.05）.The levels of serum CK,CK-MB and cTnI in the observation group were significantly lower than those in the control group at the time points of T2,T3,T4 and T5 （P 〈 0.05）.There was no significant difference in the alveolo-arterial oxygen partial pressure difference [P（A-a） O2],oxygenation index （OI） and respiratory index （RI） between the two groups at T1 （P 〉 0.05）.The P（A-a）O2 and RI at the time points oif T2,T3,T4 and T5 were significantly higher than those at T1 in the two groups （P 〈 0.05）.The OI at the time points of T2,T3,T4 and T5 was significantly lower than that at T1 in the two groups （P 〈 0.05）.The P（A-a） O2 and RI in the observation group were significantly lower than those in the control group at the time points of T2,T3,T4 and T5 （P 〈 0.05）.The OI in the observation group was significantly higher than that in the control group at the time points of T2,T3,T4 and T5 （P 〈 0.05）.There was no significant difference in the levels of serum malondialdehyde （MDA） and superoxide dismutase （SOD） between the two groups at T1 （P 〉0.05）.The level of serum MDA at the time points of T2,T3,T4 and T5 was significantly higher than that at T1 in the two groups （P 〈 0.05）.The level of serum SOD at the time points of T2,T3,T4 and Ts was significantly higher than that at T1 in the observation group（P 〈 0.05）.There was no significant difference in the level of serum SOD between the time points of T2,T3,T4,T5 and T1 in the control group （P 〉 0.05）.The level of serum MDA in the observation group was significantly lower than that in the control group at the time points of T2,T3,T4 and T5 （P 〈 0.05）.The level of serum SOD in the observation group was significantly higher than that in the control group at the time points of T2,T3,T4 and T5 （P 〈 0.05）.Conclusion Dexmedetomidine can protect heart function and lung function,and relieve oxidative stress in patients underwent valve replacement under extracorporeal circulation.
出处
《新乡医学院学报》
CAS
2017年第8期712-716,共5页
Journal of Xinxiang Medical University
基金
河南省教育厅自然科学研究计划项目(编号:2013B202306)
关键词
右美托咪啶
体外循环
瓣膜置换术
心功能
肺功能
dexmedetomidine
extracorporeal circulation
valve replacement
heart function
pulmonary function
