右美托咪定对心瓣膜置换术患者应激反应与肠黏膜屏障功能的影响

目的 研究右美托咪定对体外循环(CPB)下心瓣膜置换术患者应激反应与肠黏膜屏障功能的影响。 方法 选取40例2016年1-12月在蚌埠医学院第一附属医院拟行心瓣膜置换术的风湿性心脏病患者,采用随机数字表法随机分为对照组(C组)和右美托咪定处理组(D组),每组20例。麻醉诱导前,D组静脉输注1 μg/kg右美托咪定持续10 min,随后以0.3 μg/(kg·h)速率输注至术毕;C组输注等容量生理盐水。2组麻醉诱导与维持方法相同。采集给药前(T₀)、CPB开始前(T₁)、CPB 30 min(T₂)、停CPB即刻(T₃)、术后4 h(T₄)、术后24 h(T₅)动脉血样,检测血糖浓度、血浆皮质醇含量以及二胺氧化酶(diamine oxidase,DAO)活性。 结果 与T₀时比较,2组T₁~T₅时血糖及皮质醇浓度显著增高(均P<0.05),T₂~T₅时DAO活性显著增强(均P<0.05)。与C组比较,D组T₁~T₅时血浆Cor、T₁~T₄时血糖浓度显著降低(均P<0.05),T₂~T₅时DAO活性显著降低(均P<0.05)。 结论 右美托咪定可以改善CPB下心脏瓣膜置换术患者肠黏膜屏障功能,且可能与减轻应激反应有关。 

Effects of dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement

Objective To study the effects of Dexmedetomidine on stress response and intestinal mucosal barrier function in patients undergoing heart valve replacement under cardiopulmonary bypass (CPB). Methods Forty patients with rheumatic heart disease who were scheduled for cardiac valve replacement at the First Affiliated Hospital of Bengbu Medical College from January, 2016 to December, 2016 were randomly divided into control group (group C) and Dexmedetomidine group (group D) according to a random number table, with 20 cases in each group. Before the induction of anesthesia, the patients in group D were intravenously infused with 1 μg/kg of Dexmedetomidine for 10 min followed by continuous infusion at the rate of 0.3 μg/(kg·h) until the end of operation. While the patients in group C were given intravenously with the equal volume of normal saline. The methods of induction and maintenance of general anesthesia are the same in both two groups. Arterial blood samples were collected before administration (T₀) and just the initiation of CPB (T₁), 30 min after CPB (T₂), at the end of CPB (T₃), 4 h (T₄) and 24 h (T₅) after surgery to measure concentrations of cortisol and glucose, and the activity of diamine oxidase (DAO). Results Compared with T₀, concentrations of cortisol and blood glucose on T₁-T₅, and the activity of DAO on T₂-T₅ were significantly increased (P<0.05) in both two groups. Compared with group C, the concentration of cortisol on T₁-T₅ and blood glucose on T₁-T₄, and the activity of DAO on T₂-T₅ were significantly decreased (P<0.05) in group D. Conclusion Dexmedetomidine is capable to improve the intestinal mucosal barrier function in patients undergoing heart valve replacement under CPB, which may be related to the reduction of stress response.