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Received:September 18, 2017 Published Online:March 20, 2018
Received:September 18, 2017 Published Online:March 20, 2018
中文摘要: 目的 探讨体外循环(CBP)心血管手术患者采用不同剂量的右美托咪定对患者认知功能、应激反应状态的影响。方法 选取2015年1月至2016年9月拟实施CBP下心脏手术的患者90例,采用随机数字表法分为低剂量组(A组,麻醉诱导前静脉泵注0.5 μg/kg的右美托咪定,并以0.1 μg·kg-1·h-1至手术结束)、中剂量组(B组,麻醉诱导前静脉泵注0.8 μg/kg的右美托咪定,并以0.2 μg·kg-1·h-1至手术结束)和高剂量组(C组,麻醉诱导前静脉泵注1.0 μg/kg的右美托咪定,并以0.3 μg·kg-1·h-1至手术结束)各30例,对比各组患者不同时间点[麻醉后手术前(T0)、心肺转流(CPB)开始后30min(T1)、CPB结束后30min(T2)、术后6h(T3)、术后24h(T4)]的认知功能及应激状态指标。结果 T0时刻,A、B、C三组血清肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)、S100β蛋白浓度、补体C3、补体C4水平差异无统计学意义(P>0.05);T1~T4时刻,A组TNF-α、IL-6、补体C3、补体C4水平显著高于B组和C组(P<0.05),A组、B组S100β蛋白水平显著低于C组(P<0.05);术前1天,A、B、C三组简易精神状态量表(MMSE)评分比较差异无统计学意义(P>0.05);术后第1、4天,A组、B组MMSE评分显著高于C组(P<0.05);不良反应发生率C组显著高于A组(P<0.05)。结论 CBP下心血管手术患者麻醉诱导前静脉泵注0.8 μg/kg的右美托咪定,并以0.2 μg·kg-1·h-1至手术结束能有效的减轻患者的应激反应状态、认知功能障碍,降低不良反应发生率。
Abstract:Objective To investigate the effects of different doses of dexmedetomidine(DEX) on cognitive function and stress response in patients undergoing cardiopulmonary bypass (CBP).? Methods A total of 90 patients who intended to receive cardiac surgery under CBP from January 2015 to September 2016 were selected and was divided into low dose group (group A) in which intravenous infusion of 0.5 μg/kg DEX was given before anesthesia induction with 0.1 μg·kg-1·h-1 to the end of operation, medium dose group (group B)in which intravenous infusion of 0.8 μg/kg DEX was administered before anesthesia induction with 0.2 μg·kg-1·h-1 to the end of operation and high-dose group (group C)in which intravenous infusion of 1.0 μg/kg DEX was given before anesthesia induction with 0.3 μg·kg-1·h-1 to the end of surgery(n=30, each). The cognitive function and stress status in each group were compared at different time points of T0 (before operation after anesthesia ), T1(30 min after CPB beginning ), T2(30 min after CPB ending), T3(6 hours after operation) and T4(24 hours after operation).? Results At T0 time point, there were no significant differences in the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), S100 beta protein concentration, complement C3 and C4 among three groups (all P>0.05). At T1 to T4 time points, the levels of TNF-α, IL-6, complement C3 and C4 in group A were significantly higher than those in group B and group C (all P<0.05), and the concentration of S100β protein in group A and B was significantly lower than that in group C (all P<0.05). At one day before operation, there were no significant differences in mini-mental state examination(MMSE)scores among three groups (P> 0.05). At postoperative 1- and 4- day, MMSE scores in group A and B were significantly higher than those in group C (all P<0.05), and the incidence of adverse reactions in group C was significantly higher than that in group A (P<0.05).? Conclusion Intravenous infusion of 0.8 μg/kg DEX with 0.2 μg·kg-1·h-1 to the end of operation in patients undergoing cardiovascular surgery under CBP can effectively relieve the stress reaction state, cognitive dysfunction and reduce the incidence of adverse reactions.
keywords: Cardiopulmonary bypass Cardiovascular surgery Dexmedetomidine[, dose Cognitive function Stress response Mini-mental state examination
文章编号: 中图分类号:R 614.2,R 654.1 文献标志码:A
基金项目:梅州市科技计划项目(2016B031)
Author Name | Affiliation |
ZHONG Yu-ting, LIAO Yi-lin, LIN Yue-hua | First Division of Anesthesia Department, Meizhou City People′s Hospital, Meizhou, Guangdong 514000, China |
Author Name | Affiliation |
ZHONG Yu-ting, LIAO Yi-lin, LIN Yue-hua | First Division of Anesthesia Department, Meizhou City People′s Hospital, Meizhou, Guangdong 514000, China |
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