右美托咪定对心肺转流下行冠状动脉搭桥术患者脑损伤的减轻作用

目的 观察右美托咪定对心肺转流（CPB）下行冠状动脉搭桥术（CABG）患者血清神经元特异性烯醇化酶（NSE）、S-100蛋白B亚型（S-100B）蛋白水平及脑氧代谢指标的影响,探讨其对手术患者脑损伤的保护作用.方法 选择湖南省长沙市湘雅二医院择期CPB下行CABG的80例患者,将其平均分为实验组及对照组,实验组以微量静脉注射泵输注右美托咪定进行麻醉,对照组予以同剂量同方式生理盐水.于麻醉诱导后CPB开始前（T1）、CPB结束时（T2）、术后6 h（T3）、术后24 h（T4）、术后48 h（T5）测定血清NSE和S-100B蛋白水平,观察T1、T2、T3、T4时的颈内静脉血氧饱和度（SjvO2）、脑动-颈内静脉血氧含量差（Ca-jvO2）、动脉血氧饱和度（PaO2）、脑氧摄取率（CEO2）.结果 两组患者的NSE与S-100B蛋白在T2、T3、T4时均较T1升高,差异有统计学意义（P＜ 0.05）,且实验组各时间点浓度明显低于对照组,差异有统计学意义（P＜0.05）.两组NSE在T3达到最高峰,S-100B蛋白在T2达到最高峰.T2、T3时,实验组SjvO2、PaO2明显高于对照组,Ca-jvO2、CEO2明显低于对照组,两组比较,差异均有统计学意义（P＜0.05）.结论 右美托咪定能够降低CPB下行CABG患者的NSE及S-100B蛋白水平,降低患者的脑代谢率,提高脑内血氧饱和度,减轻CPB中造成的神经脑损伤.

Effect of Dexmedetomidine reducing the brain injury during cardiopulmonary bypass coronary artery bypass grafting

Objective To observe the changes of Dexmedetomidine influencing neuron-specific enolase （NSE）, S-100B protein level and indexes of cerebral oxygen metabolism during cardiopulmonary bypass （CPB） coronary artery bypass grafting （CABG）, and explore the protection on the operation of patients with brain injury. Methods 80 patients in the Second Xiangya Hospital of Changsha City for elective CPB downlink CABG were chosen, then they were divided into experimental group and control group. The experimental group was given Dexmedetomidine anesthesia while the control group was given physiological saline with the same dose of the same way infusion, The serum levels of NSE and S- 100B protein levels before the start of CPB and after induction of anesthesia （T1）, after the CPB （T2）, 6 h After CABG （T3）, 24 h After CABG （T4）, 48 h After CABG （Ts） were measured, and the SjvO2, Ca-jvO2, PaO2, CEO2 in T1, T2, T3, T4 were observed. Results NSE, S-100B protein in T2 T3 T4 of two groups were higher than TI, the differences were statisti- cally significant （P 〈 0.05）, and the experimental group were significantly lower than the control group in different time point, the differences were statistically significant （P 〈 0.05）. NSE of two groups reached a peak at T3, and S-100B reached a peak at T2. At T2 and T3, SjvO2, PaO2 in experimental group were significantly higher than those of the control group, and Ca-jvO2, CEO2 were significantly lower than those of the control group, the differences between the two groups were statistically significant （P 〈 0.05）. Conclusion Dexmedetomidine can reduce the levels of NSE and S- 100B protein in patients with CPB undergoing CABG, and reduce patients＂ cerebral metabolic rate, alleviate nerve in- jury caused by CPB.