CAJ | 학술논문

目的评价右美托咪啶对体外循环(CPB)心内直视手术患者脑氧代谢和糖代谢的影响.方法择期行CPB二尖瓣置换术患者58例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄32～64岁,体重52～90 kg,采用随机数字表法,将其随机分为2组(n=29):对照组(C组)和右美托咪啶组(D组).气管插管后D组静脉输注右美托咪啶0.5μg·kg-1·h-1至术毕,C组给予等容量生理盐水.分别于CPB开始前鼻咽温度为36℃时、CPB期间鼻咽温度降至30℃时、心脏复跳时以及心脏复跳30 min时采集桡动脉和颈内静脉球部血样,进行血气分析,测定血糖和乳酸浓度,计算动脉血氧含量、脑动脉-静脉血氧含量差、脑氧摄取率、脑动脉-静脉血糖含量差和脑动脉-静脉乳酸含量差.结果与C组比较,D组CPB期间鼻咽温度降至30℃时脑动脉-静脉血氧含量差和脑氧摄取率降低(P＜0.05),动脉血氧含量和糖代谢指标差异无统计学意义(P＞0.05).结论术中静脉输注右美托咪啶0.5 μg·kg-1 ·h-1可降低CPB心内直视手术患者脑氧代谢率,有助于维持脑氧供需平衡,而对脑糖代谢无明显影响.
목적 평개우미탁미정대체외순배(CPB)심내직시수술환자뇌양대사화당대사적영향.방법 택기행CPB이첨판치환술환자58례,성별불한,ASA분급Ⅱ혹Ⅲ급,년령32～64세,체중52～90 kg,채용수궤수자표법,장기수궤분위2조(n=29):대조조(C조)화우미탁미정조(D조).기관삽관후D조정맥수주우미탁미정0.5μg·kg-1·h-1지술필,C조급여등용량생리염수.분별우CPB개시전비인온도위36℃시、CPB기간비인온도강지30℃시、심장복도시이급심장복도30 min시채집뇨동맥화경내정맥구부혈양,진행혈기분석,측정혈당화유산농도,계산동맥혈양함량、뇌동맥-정맥혈양함량차、뇌양섭취솔、뇌동맥-정맥혈당함량차화뇌동맥-정맥유산함량차.결과 여C조비교,D조CPB기간비인온도강지30℃시뇌동맥-정맥혈양함량차화뇌양섭취솔강저(P＜0.05),동맥혈양함량화당대사지표차이무통계학의의(P＞0.05).결론 술중정맥수주우미탁미정0.5 μg·kg-1 ·h-1가강저CPB심내직시수술환자뇌양대사솔,유조우유지뇌양공수평형,이대뇌당대사무명현영향.
Objective To investigate the effects of dexmedetomidine on cerebral oxygen and glucose metabolism in patients undergoing mitral valve replacement under cardiopulmonary bypass (CPB).Methods Fiftyeight ASA Ⅱ or Ⅲ patients of both sexes aged 32-64 yr weighing 52-90 kg undergoing mitral valve replacement were randomly divided into 2 groups (n =29 each): control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was infused iv at 0.5 μg· kg- 1 · h- 1 starting after tracheal intubation until the end of operation in group D,while in group C equal volume of normal saline was infused instead of dexmedetomidine.Blood samples were collected from radial artery and jugular venous bulb for blood gas analysis and determination of glucose and lactate concentrations before CPB (T1,nasopharyngeal temperature =36 ℃ ),during CPB (T2,nasopharyngeal temperature =30 ℃ ),immediately and 30 min after restoration of spontaneous heart beat ( T3,T4 ).Arterial O2 content ( CaO2 ),arteriovenous O2 content difference ( Da-jvO2 ),cerebral extraction of O2 ( CEO2 ),arteriovenous glucose and lactate content differences (Da-jvGlu and Da-jvLac) were calculated.Results The Da-jvO2 and CEO2 were significantly decreased at T2 in group D as compared with group C.There was no significant difference in CaO2,Da-jvGlu and Da-jvLac between the 2 groups.Conclusion Dexmedetomidine can reduce cerebral O2 metabolism and help maintain the balance between cerebral O2 supply and demand but has no effect on cerebral glucose metabolism in patients undergoing mitral valve replacement under CPB.