中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
19期
7-9,10
,共4页
黄建华%高晓枫%卢泽安%邱荣宗%代成勇
黃建華%高曉楓%盧澤安%邱榮宗%代成勇
황건화%고효풍%로택안%구영종%대성용
右美托咪定%心脏瓣膜置换术%脑保护
右美託咪定%心髒瓣膜置換術%腦保護
우미탁미정%심장판막치환술%뇌보호
Dexmedetomidine%Cadiac valve replacement%Cerebral protection
目的：观察右美托咪定对CPB心脏瓣膜置换术患者血浆S-100β蛋白、NSE和脑氧合的影响。方法：选择择期在全麻体外循环下行瓣膜置换术的风湿性心脏瓣膜病患者40例，ASA Ⅱ~Ⅲ级，采用随机数字表法分为D组（右美托咪定组）和C组（对照组），每组各20例。采用异丙酚静脉复合全麻，D组给予右美托咪定负荷量0.5μg/kg，10 min内泵注完成，继以0.4μg/（kg·h）泵注维持至手术结束。C组给予等量生理盐水。分别于麻醉后手术前（T1）、CPB 30 min（T2）、CPB后30 min（T3）、手术结束时（T4）、术后6 h（T5）和术后24 h（T6）6个时间点采集桡动脉和颈静脉球部血进行血气分析，计算动静脉血氧含量差及脑氧摄取率；同时检测血浆S-100β蛋白和NSE浓度。结果：与T1时点比较，两组患者血浆S-100β蛋白和NSE浓度于T2~T5时点升高（P<0.05或P<0.01），两组T2~T5时点比较，D组较C组值低（P<0.05）。D组的SjvO2于T2、T3时点，C组的SjvO2于T2时点均较T1时升高（P<0.05），T2、T3时点两组比较，D组数值较C组高（P<0.05）。两组的Da-jvO2和CERO2于T2、T3时点均较T1时降低（P<0.05），T2、T3时点两组比较，D组的数值较C组低（P<0.05）。结论：右美托咪定可降低CPB下心脏瓣膜置换术患者S-100β蛋白和NSE浓度，改善脑氧供需平衡，减轻脑损伤，发挥了一定的脑保护效应。
目的：觀察右美託咪定對CPB心髒瓣膜置換術患者血漿S-100β蛋白、NSE和腦氧閤的影響。方法：選擇擇期在全痳體外循環下行瓣膜置換術的風濕性心髒瓣膜病患者40例，ASA Ⅱ~Ⅲ級，採用隨機數字錶法分為D組（右美託咪定組）和C組（對照組），每組各20例。採用異丙酚靜脈複閤全痳，D組給予右美託咪定負荷量0.5μg/kg，10 min內泵註完成，繼以0.4μg/（kg·h）泵註維持至手術結束。C組給予等量生理鹽水。分彆于痳醉後手術前（T1）、CPB 30 min（T2）、CPB後30 min（T3）、手術結束時（T4）、術後6 h（T5）和術後24 h（T6）6箇時間點採集橈動脈和頸靜脈毬部血進行血氣分析，計算動靜脈血氧含量差及腦氧攝取率；同時檢測血漿S-100β蛋白和NSE濃度。結果：與T1時點比較，兩組患者血漿S-100β蛋白和NSE濃度于T2~T5時點升高（P<0.05或P<0.01），兩組T2~T5時點比較，D組較C組值低（P<0.05）。D組的SjvO2于T2、T3時點，C組的SjvO2于T2時點均較T1時升高（P<0.05），T2、T3時點兩組比較，D組數值較C組高（P<0.05）。兩組的Da-jvO2和CERO2于T2、T3時點均較T1時降低（P<0.05），T2、T3時點兩組比較，D組的數值較C組低（P<0.05）。結論：右美託咪定可降低CPB下心髒瓣膜置換術患者S-100β蛋白和NSE濃度，改善腦氧供需平衡，減輕腦損傷，髮揮瞭一定的腦保護效應。
목적：관찰우미탁미정대CPB심장판막치환술환자혈장S-100β단백、NSE화뇌양합적영향。방법：선택택기재전마체외순배하행판막치환술적풍습성심장판막병환자40례，ASA Ⅱ~Ⅲ급，채용수궤수자표법분위D조（우미탁미정조）화C조（대조조），매조각20례。채용이병분정맥복합전마，D조급여우미탁미정부하량0.5μg/kg，10 min내빙주완성，계이0.4μg/（kg·h）빙주유지지수술결속。C조급여등량생리염수。분별우마취후수술전（T1）、CPB 30 min（T2）、CPB후30 min（T3）、수술결속시（T4）、술후6 h（T5）화술후24 h（T6）6개시간점채집뇨동맥화경정맥구부혈진행혈기분석，계산동정맥혈양함량차급뇌양섭취솔；동시검측혈장S-100β단백화NSE농도。결과：여T1시점비교，량조환자혈장S-100β단백화NSE농도우T2~T5시점승고（P<0.05혹P<0.01），량조T2~T5시점비교，D조교C조치저（P<0.05）。D조적SjvO2우T2、T3시점，C조적SjvO2우T2시점균교T1시승고（P<0.05），T2、T3시점량조비교，D조수치교C조고（P<0.05）。량조적Da-jvO2화CERO2우T2、T3시점균교T1시강저（P<0.05），T2、T3시점량조비교，D조적수치교C조저（P<0.05）。결론：우미탁미정가강저CPB하심장판막치환술환자S-100β단백화NSE농도，개선뇌양공수평형，감경뇌손상，발휘료일정적뇌보호효응。
Objective:To investigate the effects of dexmedetomidine on serum protein S-100β,neuron specific enolase and cerebral oxygenation during valve replacement surgery with cardiopulmonary bypass.Method:Forty patients undergoing elective valve replacement surgery with general anesthesia, 20 patients in each group ,ASAⅡorⅢ,were randomly divided into two groups:group D(dexmedetomidine group) and group C(control group).A loading dose of dexmedetomidine 0.5 μg/kg was injected intravenously in 10 min followed by infusion at 0.4 μg/(kg·h)until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were collected from radical artery and jugular venous bulb for blood gas analysis to calculate the cerebral arterial-venous oxygen content difference and cerebral oxygen extraction rate after anesthesia before operation(T1), CPB 30 min(T2),30 min after CPB(T3),at the end of operation(T4),6 h after operation(T5),24 h after operation(T6).The concentration of protein S-100βand NSE were detected simultaneously.Result:Compared with T1,the concentration of protein S-100βand NSE increased at T2-T5 in two groups(P<0.05 orP<0.01).Compared between two groups at T2-T5,that in group D was lower than that in group C(P<0.05).The SjvO2 in group D at T2,T3 and that in group C at T2 were higher than that at T1 (P<0.05), compared between two groups at T2-T3, that in group D was higher than that in group C(P<0.05).The Da-jvO2 and CERO2 in two groups at T2,T3 were lower than that at T1(P<0.05), compared between two groups at T2-T3, that in group D was lower than that in group C(P<0.05).Conclusion:The dexmetetomidine can reduce the concentration of protein S-100βand NSE in patients undergoing valve replacement surgery with cardiopulmonary bypass,maintain the balance of cerebral oxygen supply-consumption,alleviate brain damage and provide effective cerebral protective effect.
