CAJ | 학술논문

目的：通过对右旋美托咪啶对体外循环下心脏手术患儿星形胶质细胞S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)以及术后苏醒质量的影响，探讨右旋美托咪啶对手术患儿脑保护的价值。方法选取我院2010年2月至2014年2月行体外循环下心脏手术的72例简单先天性心脏病患儿作为研究对象，将其中应用右旋美托咪啶的32例患儿列为观察组，另40例仅运用生理盐水的患儿列为对照组，对两组患儿手术前(T1)、体外循环结束时(T2)、体外循环结束后2 h (T3)、体外循环结束后6 h (T4)、体外循环结束后24 h (T5)体内S-100β和NSE浓度变化以及术后苏醒质量进行比较分析。结果①两组患儿T1以及T5的S-100β和NSE水平差异均无统计学意义(P>0.05)，而观察组患儿的S-100β和NSE水平在T2、T3以及T4时均明显低于对照组，差异均有统计学意义(P<0.05)；②两组患儿在拔管时间、睁眼时间方面差异均无统计学意义(P>0.05)，而观察组患儿躁动发生率较对照组明显减少，且观察组躁动评分和CHIPPS评分均明显低于对照组，差异均具有统计学意义(P<0.05)。结论右旋美托咪啶可有效降低患儿体外循环过程中S-100β和NSE的浓度，减小脑损伤，同时也可有效减轻患儿术后躁动以及疼痛程度，对改善患儿术后状态有积极的作用。
목적：통과대우선미탁미정대체외순배하심장수술환인성형효질세포S-100β단백(S-100β)、신경원특이성희순화매(NSE)이급술후소성질량적영향，탐토우선미탁미정대수술환인뇌보호적개치。방법선취아원2010년2월지2014년2월행체외순배하심장수술적72례간단선천성심장병환인작위연구대상，장기중응용우선미탁미정적32례환인렬위관찰조，령40례부운용생리염수적환인렬위대조조，대량조환인수술전(T1)、체외순배결속시(T2)、체외순배결속후2 h (T3)、체외순배결속후6 h (T4)、체외순배결속후24 h (T5)체내S-100β화NSE농도변화이급술후소성질량진행비교분석。결과①량조환인T1이급T5적S-100β화NSE수평차이균무통계학의의(P>0.05)，이관찰조환인적S-100β화NSE수평재T2、T3이급T4시균명현저우대조조，차이균유통계학의의(P<0.05)；②량조환인재발관시간、정안시간방면차이균무통계학의의(P>0.05)，이관찰조환인조동발생솔교대조조명현감소，차관찰조조동평분화CHIPPS평분균명현저우대조조，차이균구유통계학의의(P<0.05)。결론우선미탁미정가유효강저환인체외순배과정중S-100β화NSE적농도，감소뇌손상，동시야가유효감경환인술후조동이급동통정도，대개선환인술후상태유적겁적작용。
Objective To observe the influence of dexmedetomidine on astrocytes S-100βprotein (S-100β), neuron specific enolization enzyme (NSE) and postoperative revival quality of children with heart operation under ex-tracorporeal circulation, and to discuss the brain protection value of dexmedetomidine for children with heart operation. Methods Seventy-two children with simple congenital heart disease who were treated by heart surgery under extra-corporeal circulation in our hospital between February 2010 and February 2014 were selected as research subjects. Thirty-two children who were treated with dexmedetomidine were enrolled in the observation group, and the other 40 children treated with normal saline were included in the control group. The level of S-100βand NSE before sur-gery (T1), at the end of the extracorporeal circulation (T2), 2 h after extracorporeal circulation (T3), 6 h after extracor-poreal circulation (T4), 24 h after extracorporeal circulation (T5) and revive quality of children in two groups were compared and analyzed. Results (1) The difference of level of S-100β and NSE at T1 and T5 between two groups were not statistically significant (P>0.05), while the level of S-100βand NSE at T2, T3, T4 of children in the observa-tion group were significantly lower than those of children in the control group;(2) There were no statistically signifi-cant differences in the extubation time and eye-opening time between the two groups (P>0.05), while compared with the control group, the incidence of restlessness in the observation group was significantly reduced, and the agitation score and CHIPPS score of children in the observation group were significantly lower (P<0.05). Conclusion Dexme-detomidine can effectively reduce the level of S-100βand NSE of children in the process of extracorporeal circula-tion, cerebellar damage, postoperative agitation and degree of pain. Therefore Dexmedetomidine has a positive effect on improving postoperative status.