右美托咪定用于体外循环下心脏瓣膜置换术患者临床观察

目的评价右美托咪定用于体外循环(CPB)下心脏瓣膜置换术患者的临床效果。方法选择我院2013年1月至2014年1月择期拟在全麻及CPB下行心脏瓣膜置换术患者60例为研究对象。采用随机数字表法,将患者随机分为两组:右美托咪定组(D组)和生理盐水对照组(C组),每组30例。麻醉诱导后,D组经10 min静脉输注右美托咪定1μg/kg,随后以0.5μg/(kg·h)速度输注至术毕;C组以同样方法静脉输注等容量生理盐水。分别于麻醉诱导前(T_0)、停CPB后10 min(T_1)、术毕(T_2)、术后6 h(T_3)和术后24 h(T_4)时采集静脉血样,采用ELISA法测定血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-10(IL-10)以及肌酸激酶同工酶(CK-MB)、血清肌钙蛋白Ⅰ(CTnI)的水平;并记录两组患者主动脉开放后心脏自动复跳情况和术中血管活性药物(多巴胺、去甲肾上腺素和肾上腺素)使用情况。结果与T_0时比较,T_1~T_4时两组患者血清TNF-α、IL-6、IL-10及CK-MB、CTnI浓度升高(P<0.05);与C组比较,D组T_1~T_4时血清TNF-α及IL-6浓度降低,IL-10浓度升高,T_3~T_4时血清CK-MB及CTnI浓度降低,主动脉开放后心脏自动复跳率升高,术中多巴胺用量、去甲肾上腺素用量及肾上腺素使用率降低(P<0.05)。结论右美托咪定可减轻CPB下心脏瓣膜置换术患者围术期炎性反应,并可产生一定的心肌保护作用。

Clinical efficacy of dexmedetomidine in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To evaluate the clinical efficacy of dexmedetomidine in patients undergoing cardiac valve replacement with car-diopulmonary bypass(CPB). Methods Totally 60 patients who were scheduled for cardiac valve replacement with CPB were randomly divided into 2 groups(n=30,each):dexmedetomidine group(Group D) and normal saline control group(Group C). Dexmedetomidine 1 μg/kg was infused iv over 10 minutes after anesthesia induction,and then was infused at a rate of 0. 5 μg/( kg·h) until the end of operation in Group D. Group C received the equal volume of normal saline. Venous blood samples were taken before anesthesia induc-tion(T0),at 10 minutes after termination of cardiopulmonary bypass(T1),at the end of operation(T2),and at 6 hours(T3) and 24 hours(T4) after operation for determination of serum levels of TNF-α,IL-6,IL-10,creatine kinase MB(CK-MB)and cardiac troponin I ( CTnI) by ELISA. The condition of spontaneous heart beats and requirement for vasoactive drugs( dopamine,norepinephrine,epineph-rine) were also recorded. Results Compared with T0 ,serum level of TNF-α,IL-6,IL-10,CK-MB and CTnI was increased at T1-T4 in both two groups(P<0. 05). Compared with Group C,serum level of TNF-αand IL-6 was decreased,and the serum level of IL-10 was increased at T1-T4,serum CK-MB and CTnI were decreased at T3-T4,the rate of spontaneous heart beats was increased,the consump-tion of norepinephrine and dopamine,and requirement for epinephrine were significantly lower in Group D(P<0. 05). Conclusion Dexmedetomidine can attenuate the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary by-pass and provide myocardial protection to some extent.