右美托咪定对CPB心脏瓣膜置换术患者血浆S-100β蛋白、NSE和脑氧合的影响

Effects of Dexmedetomidine on Serum Protein S-100β,Neuron Specific Enolase and Cerebral Oxygenation during Valve Replacement Surgery with Cardiopulmonary Bypass

目的：观察右美托咪定对CPB心脏瓣膜置换术患者血浆S-100β蛋白、NSE和脑氧合的影响。方法：选择择期在全麻体外循环下行瓣膜置换术的风湿性心脏瓣膜病患者40例,ASAⅡ～Ⅲ级,采用随机数字表法分为D组（右美托咪定组）和C组（对照组）,每组各20例。采用异丙酚静脉复合全麻,D组给予右美托咪定负荷量0.5μg/kg,10 min内泵注完成,继以0.4μg/（kg·h）泵注维持至手术结束。C组给予等量生理盐水。分别于麻醉后手术前（T1）、CPB 30 min（T2）、CPB后30 min（T3）、手术结束时（T4）、术后6 h（T5）和术后24 h（T6）6个时间点采集桡动脉和颈静脉球部血进行血气分析,计算动静脉血氧含量差及脑氧摄取率;同时检测血浆S-100β蛋白和NSE浓度。结果：与T1时点比较,两组患者血浆S-100β蛋白和NSE浓度于T2～T5时点升高（P〈0.05或P〈0.01）,两组T2～T5时点比较,D组较C组值低（P〈0.05）。D组的SjvO2于T2、T3时点,C组的SjvO2于T2时点均较T1时升高（P〈0.05）,T2、T3时点两组比较,D组数值较C组高（P〈0.05）。两组的Da-jvO2和CERO2于T2、T3时点均较T1时降低（P〈0.05）,T2、T3时点两组比较,D组的数值较C组低（P〈0.05）。结论：右美托咪定可降低CPB下心脏瓣膜置换术患者S-100β蛋白和NSE浓度,改善脑氧供需平衡,减轻脑损伤,发挥了一定的脑保护效应。

Objective：To investigate the effects of dexmedetomidine on serum protein S-100β,neuron specific enolase and cerebral oxygenation during valve replacement surgery with cardiopulmonary bypass.Method：Forty patients undergoing elective valve replacement surgery with general anesthesia, 20 patients in each group ,ASAⅡorⅢ,were randomly divided into two groups：group D（dexmedetomidine group） and group C（control group）.A loading dose of dexmedetomidine 0.5 μg/kg was injected intravenously in 10 min followed by infusion at 0.4 μg/（kg·h）until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were collected from radical artery and jugular venous bulb for blood gas analysis to calculate the cerebral arterial-venous oxygen content difference and cerebral oxygen extraction rate after anesthesia before operation（T1）, CPB 30 min（T2）,30 min after CPB（T3）,at the end of operation（T4）,6 h after operation（T5）,24 h after operation（T6）.The concentration of protein S-100βand NSE were detected simultaneously.Result：Compared with T1,the concentration of protein S-100βand NSE increased at T2-T5 in two groups（P〈0.05 orP〈0.01）.Compared between two groups at T2-T5,that in group D was lower than that in group C（P〈0.05）.The SjvO2 in group D at T2,T3 and that in group C at T2 were higher than that at T1 （P〈0.05）, compared between two groups at T2-T3, that in group D was higher than that in group C（P〈0.05）.The Da-jvO2 and CERO2 in two groups at T2,T3 were lower than that at T1（P〈0.05）, compared between two groups at T2-T3, that in group D was lower than that in group C（P〈0.05）.Conclusion：The dexmetetomidine can reduce the concentration of protein S-100βand NSE in patients undergoing valve replacement surgery with cardiopulmonary bypass,maintain the balance of cerebral oxygen supply-consumption,alleviate brain damage and provide effective cerebral protective effect.