右美托咪定对心肺转流瓣膜置换术患者S100β蛋白和神经元特异性烯醇化酶的影响

Effects of dexmedetomidine on the change of S100β protein and neuron specific enolase level during cardiopulmonary bypass in cardiac valve replacement surgery

目的探讨右美托咪定对心肺转流(CPB)瓣膜置换术患者血浆S100β蛋白和神经元特异性烯醇化酶(NSE)的影响。方法择期在CPB下行瓣膜置换术的患者30例,随机均分为两组,分别在麻醉诱导完成后静脉泵注右美托咪定0.2μg·kg-1·h-1(D组)或等量生理盐水(C组)。分别在麻醉诱导后切皮前(T1)、复温时(T2)、主动脉开放时(T3)、CPB后6h(T4)、24h(T5)采集颈内静脉血,用ELISA法检测血浆S100β蛋白和NSE含量。结果与T1时比较,T2～T4时两组S100β蛋白和NSE含量均明显升高(P<0.01),在T5时恢复至T1时水平。与C组比较,T2～T4时D组S100β蛋白和NSE含量明显降低(P<0.01)。结论术中泵入右美托咪定可有效降低CPB瓣膜置换术时血浆中S100蛋白和NSE的含量,减轻CPB脑损伤。

Objective To evaluate the effects of dexmedetomidine on the change of $10013 protein and neuron specific enolase （NSE） level during cardiopulmonary bypass （CPB） in cardiac valve replacement surgery. Methods Thirty patients scheduled for cardiac valve replacement were randomly divided into two groups. Dexmedetomidine at the dose of 0. 2 b^g. kg 1. h-1 and the same volume of saline was infused intravenously after induction of anesthesia in the group D and group C respectively. Blood samples were taken from internal jugular vein in each of the following five time points., after induction of anesthesia （T1）, at rewarming （T2）, aortic declamping （Ts）, after the termination of CPB 6 h（T4 ） and 24 h （Ts） for determination of S100~3 protein and NSE by ELISA. Results Plasma S10013 protein and NSE rose significantly at the time of T2-T4 than that at T1 in both groups （P^0.01）. At the time of Ta all plasma returned to preoperative levels in both groups. The concentration of S10013 protein and NSE levels in group D were significantly lower than those in group C （P^0.01） at the time of T2-T4. Conclusion Dexmedetomidine can reduce the release of the protein and NSE and alleviate the brain injury resulting from cardiopulmonary bypass in cardiac valve replacement surgery.