右美托咪定对全麻体外循环下瓣膜置换术患者术后康复的影响

目的观察右美托咪定（ Dex）对全麻体外循环下瓣膜置换术患者术中循环状况及术后加速康复的影响。方法选择气管插管全麻体外循环下瓣膜置换术患者52例（ ASAⅡ～Ⅲ级），用随机数字表法将患者分成两组，D组（n＝26）在麻醉诱导前予以Dex 0.5μg／kg＋生理盐水50 mL，泵注时间保持在15～20 min内，术中用0.3μg／kg持续泵注（体外循环期间Dex泵注体外循环机内），直至手术结束；C组（对照组，n＝26）则予以等量生理盐水静脉输注。观察患者平均动脉压（ MAP）、心率（ HR）、脉搏血氧饱和度（ SpO2）、呼吸频率（ RR）及麻醉深度（ BIS），记录并比较手术时间、体外循环时间；术后苏醒时间、ICU监护时间及住院时间；随访1、3及7 d患者MMSE评分。结果两组的手术前MAP对比差异无统计学意义（ P＞0.05），而D组的手术中和手术后MAP分别为（71.16±6.54）mmHg、（78.02±5.48）mmHg，较C组更低（P＜0.05）；D组手术中以及手术后的HR分别为（64.32±5.18）次／min、（72.10±6.33）次／min，均低于C组（P＜0.05）；手术中D组BIS值为45.28±5.31，比C组（52.14±6.03）有明显下降（P ＜0.05）；D组的丙泊酚诱导、丙泊酚总量及舒芬太尼用量分别为（0.74±0.12） mg／kg、（358.24±67.43）mg、（17.94±3.02）μg／kg，均显著低于C组（P ＜0.05）；高血压、心动过速等不良反应 D组（7.70％）低于C组（P＞0.05）；D组术后苏醒时间、ICU时间及住院时间分别为（3.47±1.21）h、（4.71±0.54）d、（11.43±3.20）d，均明显短于C组（P＜0.05）；两组患者手术后3 d的MMSE评分均较手术前下降（P＜0.05），且D组术后3 d和7 d的MMSE评分依次为（26.34±1.54）分、（27.54±2.11）分，均显著高于C组（ P＜0.05）。结论全麻体外循环下瓣膜置换术患者诱导前以Dex 0.5μg／kg泵注10～15 min，术中用0.3μg／kg持续泵注，有利于麻醉诱导和术中循环的稳定，缩短复苏时间及住院时间，有利于患者术后的康复，减少ICU时间及住院时间，减少患者出现术后认知功能障碍，值得临床上推荐选用。

Clinical efficacy of deximedetomidine in patients undergoing cardiac valve replacement with cardiopulmonary by-pass

Objective To analyzed the effects of dexmedetomidine ( Dex) on the circulation and enhanced recover-y after surgery during cardiopulmonary bypass ( CPB ) in patients undergoing valve replacement .Methods Fifty-two patients scheduled for mitral valve replacement under CPB with general anesthesia and endotracheal intubation ( ASAⅡ~Ⅲ)were randomly divided into two groups, Group D(n=26), in which subjects received Dex(0.5 μg/kg)plus 50 mL normal saline infusion before induction , and intraoperatively continuous infusion of Dex (0.3μg/kg) until the end of sur-gery;and Group C ( control group , n=26 ) , in which normal saline as placebo were given .The mean arterial pressure (MAP), heart rate(HR), pulse oxygen saturation (SpO2), respiratory rate (RR) and the depth of anesthesia (BIS) were recorded and compared;and so were the operation time , CPB time, postoperative recovery time , ICU monitoring time and hospitalization stay.During the follow-ups on the 1st, 3rd and 7th day, the MMSE were recorded.Results There was no significant difference in MAP between the two groups before surgery (P>0.05), while it was significantly lower in Group D during and after operation [ ( 71.16 ±6.54 ) mmHg and ( 78.02 ±5.48 ) mmHg, respectively ] than Group C (P<0.05).So were the HRs during and after operation in Group D [(64.32 ±5.18)bpm and (72.10 ±6.33)bpm, re-spectively, P<0.05].The BIS in Group D (45.28 ±5.31) was significantly lower than that in Group C (P<0.05). The usage of propofol during induction , the total amounts of propofol and sufentanil [(0.74 ±0.12)mg/kg, (358.24 ± 67.43)mg/kg and (17.94 ±3.02)μg/kg, respectively] were significantly lower than in those in Group C (P<0.05). The incidence of hypertension and heart rate adverse reaction in Group D (7.70%) was lower than that in Group C (P>0.05).The postoperative recovery time, duration of ICU and hospital stay in Group D [(3.47 ±1.21)h, (4.71 ±0.54) d and (11.43 ±3.20)d, respectively] were significantly shorten than Group C (P<0.05).The MMSE scores in the two groups after surgery were significantly lower than before surgery (P<0.05).The MMSE scores on the 3rd and the 7th day in Group D (26.34 ±1.54 and 27.54 ±2.11, respectively) were significantly higher than those in Group C (P<0.05). Conclusion The application of Dex during induction and general anesthesia for CBP operation is conducive to anesthesia induction and operation cycle stability , shorten the recovery time and hospital stay , conducive to the rehabilitation of the patients after surgery , reduces the ICU and hospital stay , alleviates postoperative cognitive dysfunction in patients .