CAJ | 학술논문

目的评价右美托咪定对体外循环(CPB)下心脏瓣膜置换术患者肠黏膜损伤的影响.方法择期行心脏瓣膜置换术的风湿性心脏病患者40例,性别不限,年龄32 ～ 64岁,体重40～75 kg,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,采用随机数字表法,将患者分为2组(n=20):对照组(C组)和右美托咪定组(D组).全麻诱导气管插管后行机械通气,麻醉维持:吸入0.8％～2.0％七氟醚,间断静脉注射舒芬太尼0.5～ 1.0 μg/kg和维库溴铵0.04～ 0.06 mg/kg.D组于常规麻醉诱导前经10 min静脉注射右美托咪定1μg/kg负荷量,随后以0.3 μg·kg-1· h-1速率静脉输注至术毕.分别于CPB开始前、主动脉阻断后30 min、CPB结束时、术毕、术后6h、术后24 h时采集中心静脉血样,采用ELISA法检测血浆TNF-α、IL-6、IL-10和肠型脂肪酸结合蛋白的浓度,采用比浊光度法测定血浆内毒素浓度.记录术后机械通气时间与ICU停留时间.结果与C组比较,D组血浆TNF-α、IL-6、IL-10、肠型脂肪酸结合蛋白和内毒素的浓度降低,术后机械通气时间和ICU停留时间缩短(P＜0.05).结论常规麻醉诱导前静脉输注右美托咪定1 μg/kg负荷量,随后以0.3 μg· kg-1 ·h-1速率输注至术毕可减轻CPB下心脏瓣膜置换术患者肠黏膜损伤.
목적 평개우미탁미정대체외순배(CPB)하심장판막치환술환자장점막손상적영향.방법 택기행심장판막치환술적풍습성심장병환자40례,성별불한,년령32 ～ 64세,체중40～75 kg,ASA분급Ⅱ혹Ⅲ급,NYHA심공능분급Ⅱ혹Ⅲ급,채용수궤수자표법,장환자분위2조(n=20):대조조(C조)화우미탁미정조(D조).전마유도기관삽관후행궤계통기,마취유지:흡입0.8％～2.0％칠불미,간단정맥주사서분태니0.5～ 1.0 μg/kg화유고추안0.04～ 0.06 mg/kg.D조우상규마취유도전경10 min정맥주사우미탁미정1μg/kg부하량,수후이0.3 μg·kg-1· h-1속솔정맥수주지술필.분별우CPB개시전、주동맥조단후30 min、CPB결속시、술필、술후6h、술후24 h시채집중심정맥혈양,채용ELISA법검측혈장TNF-α、IL-6、IL-10화장형지방산결합단백적농도,채용비탁광도법측정혈장내독소농도.기록술후궤계통기시간여ICU정류시간.결과 여C조비교,D조혈장TNF-α、IL-6、IL-10、장형지방산결합단백화내독소적농도강저,술후궤계통기시간화ICU정류시간축단(P＜0.05).결론 상규마취유도전정맥수주우미탁미정1 μg/kg부하량,수후이0.3 μg· kg-1 ·h-1속솔수주지술필가감경CPB하심장판막치환술환자장점막손상.
Objective To evaluate the effect of dexmedetomidine on the intestinal mucosal injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 40-75 kg,of ASA physical status Ⅱ or Ⅲ (NYHA class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and dexmedetomidine group (group D).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with 0.8％-2.0％ sevoflurane inhalation and intermittent iv boluses of sufentanil 0.5-1.0 μg/kg and vecuronium 0.04-0.06 mg/kg.Before routine induction of anesthesia,a loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min,followed by continuous infusion at 0.3 μg · kg-1 · h-1 until the end of surgery in group D,while the equal volume of normal saline was given in group C.Before CPB,at 30 min after aortic clamping,at the termination of CPB,at the end of surgery and at 6 and 24 h after surgery,central venous blood samples were taken for determination of concentrations of tumor necrosis factor-alpha,interleukin-6 (IL-6) and IL-10 and intestinal fatty acid binding protein in plasma (by ELISA),and the plasma concentration of endotoxin (using turbidimetry).The time of postoperative mechanical ventilation and duration of ICU stay were recorded.Results Compared with group C,the concentrations of tumor necrosis factor-alpha,IL-6,IL-10 and endotoxin and intestinal fatty acid binding protein in plasma were significantly decreased,and the time of postoperative mechanical ventilation and duration of ICU stay were shortened in group D.Conclusion Dexmedetomidine infused continuously at 0.3 μg · kg-1 · h-1 (until the end of surgery) after a loading dose of 1 μg/kg before routine induction of anesthesia can reduce intestinal mucosal injury in the patients undergoing cardiac valve replacement with CPB.