文章摘要

右美托咪定对体外循环心脏瓣膜置换术患者血流动力学、氧化应激及术后认知功能的影响

作者: 1刘金帅, 1宋磊军, 1朱雅萍, 2浮志坤
1 郑州市第七人民医院(郑州市心血管病医院)麻醉科，郑州 450000
2 郑州市第七人民医院(郑州市心血管病医院)心脏外科，郑州 450000
通讯: 刘金帅 Email: liujinshuai01@163.com
DOI: 10.3978/j.issn.2095-6959.2022.07.019
基金: 河南省医学科技攻关计划项目(2018020861)。

摘要

目的：探讨右美托咪定对体外循环(cardiopulmonary bypass，CPB)心脏瓣膜置换术患者血流动力学、氧化应激及术后认知功能的影响。方法：回顾性分析2016年12月至2020年12月于郑州市第七人民医院行CPB心脏瓣膜置换术的160例心脏病患者临床资料，其中使用右美托咪定82例(A组)，未使用右美托咪定78例(B组)。比较两组术中麻醉药用量，麻醉诱导前(T0)、麻醉诱导后10 min(T1)、升主动脉阻断后10 min(T2)、降温至30℃平稳后10 min(T3)、复温至37 ℃(T4)及停止CPB后10 min(T5)时血流动力学指标，术前1 d、术后1 d及术后3 d氧化应激指标、认知功能，记录不良反应。结果：A组咪达唑仑、舒芬太尼及丙泊酚用量均少于B组(P<0.05)；A组T5时刻心率(heart rate，HR)及T2、T3、T5时刻平均动脉压(mean arterial pressure，MAP)均高于B组(P<0.05)；术后1d、3d，A组丙二醛(malonaldehyde，MDA)水平及蒙特利尔认知功能量表(Montreal Cognitive Assessment，MoCA)评分明显高于B组，而超氧化物歧化酶(superoxide dismutase，SOD)水平明显低于B组(P<0.05)；两组不良反应比较差异无统计学意义(P>0.05)。结论：右美托咪定能在减少麻醉药用量且不增加麻醉相关不良反应的基础上降低CPB心脏瓣膜置换术患者术中升高的血压和加快的心率，稳定血流动力学，减轻氧化应激反应，并改善患者术后认知功能。
关键词： 右美托咪定；心脏瓣膜置换术；体外循环；血流动力学；氧化应激；认知功能

Influence of dexmedetomidine on hemodynamics, oxidative stress, and postoperative cognitive function in patients undergoing cardiac valve replacement under cardiopulmonary bypass

Authors: 1LIU Jinshuai, 1SONG Leijun, 1ZHU Yaping, 2FU Zhikun
1 Department of Anesthesiology, Zhengzhou Seventh People’s Hospital (Zhengzhou Cardiovascular Hospital), Zhengzhou 450000, China
2 Department of Cardiac Surgery, Zhengzhou Seventh People’s Hospital (Zhengzhou Cardiovascular Hospital), Zhengzhou 450000, China

CorrespondingAuthor: LIU Jinshuai Email: liujinshuai01@163.com

DOI: 10.3978/j.issn.2095-6959.2022.07.019

Foundation: This work was supported by the Henan Medical Science and Technology Research Program, China (2018020861).

Abstract

Objective: To investigate the influence of dexmedetomidine on hemodynamics, oxidative stress and postoperative cognitive function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods: This study retrospectively reviewed 160 patients with heart disease who underwent cardiac valve replacement under CPB at Zhengzhou Seventh People's Hospital from December 2016 to December 2020. Among them, 82 patients were treated with dexmedetomidine were included in group A, and 78 patients not treated with dexmedetomidine were included in group B. The two groups were compared in terms of intraoperative dosage of anesthetics, hemodynamic indicators before induction of anesthesia (T0), at 10 min after induction of anesthesia (T1), 10 min after ascending aorta block (T2), 10 min after the temperature dropped to 30 ℃ and became stable (T3), temperature back to 37 ℃ (T4) and 10 min after the end of CPB (T5), oxidative stress indicators and cognitive function at 1 day before operation, on day 1 and day 3 after operation. Adverse reactions were recorded. Results: The dosages of midazolam, sufentanil and propofol in group A were lower than those in group B (P<0.05). Heart rate (HR) of group A at T5 and mean arterial pressure (MAP) at T2, T3 and T5 were higher than those of group B (P<0.05). On day 1 and day 3 after operation, malonaldehyde (MDA) levels and the Montreal Cognitive Assessment (MoCA) scores of group A were significantly higher than those of group B, and superoxide dismutase (SOD) levels were significantly lower than those in group B (P<0.05). There was no statistically significant difference in adverse reactions between the two groups (P>0.05). Conclusion: Dexmedetomidine can reduce increases in blood pressure and heart rate of patients during cardiac valve replacement under CPB, stabilize hemodynamics, reduce oxidative stress, and improve cognitive function in the patients after operation while reducing the dosage of anesthetic, without increasing anesthesia-associated adverse reactions.

Keywords： dexmedetomidine; cardiac valve replacement; cardiopulmonary bypass; hemodynamics; oxidative stress; cognitive function

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