右美托咪定对风湿性心脏病瓣膜置换术患者炎性反应的影响

目的探讨右美托咪定对风湿性心脏病瓣膜置换术患者炎性反应的影响。方法将我院收治的195例体外循环（CPB）下行瓣膜置换术的风湿性心脏病患者,按照随机分层分组法分为观察组和对照组,两组麻醉诱导完成后分别给予右美托咪定和生理盐水,分别于切皮前（T1）、CPB即刻（T2）、CPB开始2 h（T3）、CPB结束（T4）及CPB结束后24 h（T5）检测两组血清白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、S100β蛋白和神经元特异性烯醇化酶（NSE）含量,同时观察两组动脉血氧分压（PaO2）和脑氧摄取率（ERO2）。结果两组T3、T4血清IL-6、TNF-α、S100β蛋白及NSE含量显著高于T1、T2（P〈0.05）。观察组T1、T2血清IL-6、TNF-α、S100β蛋白及NSE含量与对照组比较差异无统计学意义（P〉0.05）,但观察组T3、T4和T5的血清IL-6、TNF-α、S100β蛋白及NSE含量显著低于对照组（P〈0.05）。两组T1、T2、T5的PaO2和ERO2比较差异无统计学意义（P〉0.05）,观察组T3、T4的PaO2和ERO2高于对照组,两组比较差异有统计学意义（P〈0.05）。结论瓣膜置换术中泵入右美托咪定能显著降低CPB导致的炎性因子水平增高,降低血清S100β蛋白及NSE含量,具有较好的抗炎和脑保护作用。

Effects of dexmedetomidine on the serum levels of inflammatory cytokines in patients with rheumatic heart valve replacement surgery

Objective To explore the effects of dexmedetomidine on the serum levels of inflammatory cytokines in patients with rheumatic heart valve replacement surgery.Methods According to a stratified randomization method,195 cases of patients with rheumatic heart were divided into observation group and control group,observation group was given dexmedetomidine after induction of anesthesia,control group was given saline,the serum levels of IL-6,TNF-α,S100β protein and NSE of the two groups were observed,and PaO2and ERO2of the two groups were observed after induction of anesthesia（T1）,the beginning of CPB（T2）,after beginning of CPB 2 h（T3）,the end of CPB（T4） and after the termination of CPB 24 h（T5）.Results The serum levels of IL-6,TNF-α,S100β protein and NSE of the two groups rose significantly at the time of T3and T4（P〈 0.05）.The concentration of the serum levels of IL-6,TNF-α,S100β protein and NSE showed no significantly difference between the two groups（P 〉0.05）,but the observation group was significantly lower than the control group in the levels of IL-6,TNF-α,S100β protein and NSE at the time points of T3,T4,T5（P 〈0.05）.The concentration of PaO2and ERO2showed no significant difference between the two groups at the time points of T1,T2and T5（P〉 0.05）,the observation group was significantly higher than the control group in PaO2and ERO2at the time points of T3and T4（P 0.05）.Conclusion Dexmedetomidine may alleviate the systemic inflammatory reaction resulting from cardiopulm-onary bypass in cardiac valve replacement surgery,it has a good anti-inflammatory and neuroprotective effects.