中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2013年
4期
749-752
,共4页
周红梅%肖旺频%王奎荣%祝胜美
週紅梅%肖旺頻%王奎榮%祝勝美
주홍매%초왕빈%왕규영%축성미
右美托咪定%脑氧代谢%脑保护%神经元特异性烯醇化酶%S-100β蛋白
右美託咪定%腦氧代謝%腦保護%神經元特異性烯醇化酶%S-100β蛋白
우미탁미정%뇌양대사%뇌보호%신경원특이성희순화매%S-100β단백
Dexmedetomidine%Cerebral oxygen metabolism%Cerebral protection%Neuron specific enolase%S-100β protein
目的 观察右美托咪定对体外循环(CPB)下瓣膜置换术患者脑氧代谢的影响及对脑缺血损伤的保护作用.方法 30例心脏手术患者随机分成A组和B组,每组15例.A组麻醉诱导前给予0.5 μg/kg右美托咪定负荷量,后以0.5 μg/(kg·h)继续泵注维持至手术结束.B组给予0.9％氯化钠输注,其余同A组.分别在T1～T7时点留取桡动脉血和颈内静脉球部血行血气分析,并留血测定血浆S100-β蛋白和神经元特异性烯醇化酶(NSE)浓度.结果 两组患者SjvO2、ERO2在T1时点比较差异无统计学意义(P＞0.05)；两组患者SjvO2在T5时点分别为(71.7±6.2)％、(65.0±6.1)％,与A组比较,B组下降明显(P＜0.05),两组患者ERO2在T5时点分别为(27.9±7.2)％、(33.8±7.6)％,与A组比较,B组上升明显(P＜0.05)；与T1时点比较,两组患者血浆S-100β蛋白和NSE在T6、T7两个时点均明显升高(P＜0.01),且A明显低于B组(P＜0.05).结论 在心脏手术患者围手术期使用右美托咪定可以降低CPB复温期的脑氧摄取率,避免复温期的脑氧供需失衡,并可减轻大脑的缺血性损伤,有一定的脑保护作用.
目的 觀察右美託咪定對體外循環(CPB)下瓣膜置換術患者腦氧代謝的影響及對腦缺血損傷的保護作用.方法 30例心髒手術患者隨機分成A組和B組,每組15例.A組痳醉誘導前給予0.5 μg/kg右美託咪定負荷量,後以0.5 μg/(kg·h)繼續泵註維持至手術結束.B組給予0.9％氯化鈉輸註,其餘同A組.分彆在T1～T7時點留取橈動脈血和頸內靜脈毬部血行血氣分析,併留血測定血漿S100-β蛋白和神經元特異性烯醇化酶(NSE)濃度.結果 兩組患者SjvO2、ERO2在T1時點比較差異無統計學意義(P＞0.05)；兩組患者SjvO2在T5時點分彆為(71.7±6.2)％、(65.0±6.1)％,與A組比較,B組下降明顯(P＜0.05),兩組患者ERO2在T5時點分彆為(27.9±7.2)％、(33.8±7.6)％,與A組比較,B組上升明顯(P＜0.05)；與T1時點比較,兩組患者血漿S-100β蛋白和NSE在T6、T7兩箇時點均明顯升高(P＜0.01),且A明顯低于B組(P＜0.05).結論 在心髒手術患者圍手術期使用右美託咪定可以降低CPB複溫期的腦氧攝取率,避免複溫期的腦氧供需失衡,併可減輕大腦的缺血性損傷,有一定的腦保護作用.
목적 관찰우미탁미정대체외순배(CPB)하판막치환술환자뇌양대사적영향급대뇌결혈손상적보호작용.방법 30례심장수술환자수궤분성A조화B조,매조15례.A조마취유도전급여0.5 μg/kg우미탁미정부하량,후이0.5 μg/(kg·h)계속빙주유지지수술결속.B조급여0.9％록화납수주,기여동A조.분별재T1～T7시점류취뇨동맥혈화경내정맥구부혈행혈기분석,병류혈측정혈장S100-β단백화신경원특이성희순화매(NSE)농도.결과 량조환자SjvO2、ERO2재T1시점비교차이무통계학의의(P＞0.05)；량조환자SjvO2재T5시점분별위(71.7±6.2)％、(65.0±6.1)％,여A조비교,B조하강명현(P＜0.05),량조환자ERO2재T5시점분별위(27.9±7.2)％、(33.8±7.6)％,여A조비교,B조상승명현(P＜0.05)；여T1시점비교,량조환자혈장S-100β단백화NSE재T6、T7량개시점균명현승고(P＜0.01),차A명현저우B조(P＜0.05).결론 재심장수술환자위수술기사용우미탁미정가이강저CPB복온기적뇌양섭취솔,피면복온기적뇌양공수실형,병가감경대뇌적결혈성손상,유일정적뇌보호작용.
Objective To evaluate the protective effect of dexmedetomidine against cerebral ischemic injury of patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass (CPB).Methods Thirty patients undergoing cardiac valve replacement surgery were allocated randomly into group A and group B,15 cases each group.In group A,0.5 μg/kg dexmedetomidine was given as a loading dose,then maintained with the dose of 0.5 μg/(kg·h),In group B,the dexmedetomidine was insteaded by O.9％ sodium chloride.At T1-T7 time points,arterial and jugular venous blood were collected for blood gas analyses; At T1,T3,T5,T6 and T7 time points,Plasma concentration of S-100β and neuron specific enolase (NSE) were measured.Results There was no difference in SjvO2 and ERO2 between two groups at T1.In group A and B,the SjvO2 was (71.7 ± 6.2) ％ and (65.0 ± 6.1) ％ separately at T5 ; compared with group A,the SjvO2 in group B decreased significantly(P ＜0.05) ; In group A and B,the ERO2 was (27.9±7.2)％ and(33.8 ±7.6)％ separately at T5; compared with group A,the ERO2 in group B increased significantly(P ＜0.05); Compared with T1,the Plasma concentration of S-100β and NSE at T6 and T7 increased significantly in both two groups (P ＜ 0.01),especially in group B (P ＜ 0.05).Conclusion Dexmedetomidine can reduce cerebral oxygen uptake rate,avoid cerebral oxygen supply-demand imbalance and reduce cerebral ischemic injury in rewarming period during cardiopulmonary bypass in cardiac valve replacement surgery,which bring about certain cerebral protective effects for those patients.
