右美托咪定辅助全麻对患者心脑缺血再灌注损伤的保护作用

Protective Effects of Adjuvant General Anesthesia of Dexmedetomidine on Cardiac and Cerebral Ischemia-perfusion Injury

目的：考察右美托咪定辅助全麻对患者心脑缺血再灌注损伤的保护作用。方法：选择美国麻醉师协会（ASA）分级Ⅰ~Ⅱ级拟行气管插管的患者共50例,按随机数字表法分为右美托咪定组（D组）和对照组（C组）,每组25例。D组患者于全麻前以1μg/kg右美托咪定负荷剂量静脉泵注10 min后,再以0.5μg/（kg·h）维持剂量至手术结束;C组患者给予生理盐水,其余处理相同。监测两组患者手术开始时、切皮后10 min、切皮后30 min以及手术结束时的心率（HR）、收缩压（SBP）、舒张压（DBP）;分别于全麻诱导前（T0）、手术结束时（T1）、术后6 h（T2）、术后12 h（T3）、术后24 h（T4）、术后48 h（T5）6个时点采集患者颈内静脉血,检测心肌肌钙蛋白Ⅰ（cTnⅠ）、肾上腺素和去甲肾上腺素的水平。结果：D组患者手术过程各时点的HR、SBP、DBP水平与手术开始时比较差异无统计学意义（P〉0.05）,且显著低于C组相应时点的测定值,差异有统计学意义（P〈0.05）;D组患者的cTnⅠ质量浓度在T2~T5时间点显著低于C组,差异有统计学意义（P〈0.05）;D组肾上腺素和去甲肾上腺素质量浓度在T1~T5时点显著低于C组,差异有统计学意义（P〈0.05）。结论：右美托咪定辅助全麻能在一定程度上改善患者心脑缺血再灌注损伤。

OBJECTIVE： To investigate the protective effects of adjunctive general anesthesia of dexmedetomidine on cardiac and cerebral ischemia-perfusion injury. METHODS： 50 patients, ASA physical status Ⅰ- Ⅱ, undergoing selective tracheal intuba- tion, were randomly divided into dexmedetomidine group （group D） and control group （group C） with 25 cases in each group. The patients in group D received a loading dose of 1 μg/kg of dexmedetomidine by infusion pump before anaesthesia, 10 min lat- er by a maintenance dose of 0.5 μg/（kg.h） till the end of surgery; whereas patients in group C received normal saline and same induction. HR, SBP and DBP of 2 groups were monitored at the beginning of operation, 10 min after incision, 30 min after inci- sion, at the end of operation. Blood samples of vena jugularis interna were taken to determine the plasma levels of cardiac tropo- nin Ⅰ （cTn Ⅰ ） , adrenaline and norepinephrine before anesthesia induction （T0）, at the end of surgery （T1）, 6 h after surgery （T2）, 12 h after surgery （T3）, 24 h after surgery （T4）, 48 h after surgery （T0）. RESULTS： There was no statistical significance in the levels of HR, SBP and DBP in group D between during operation and at the beginning of operation （P〉0.05） ; those in- dex were significantly lower than those of group C at corresponding time points, with statistical significance （P〈0.05）. The lev- els of cTn I in group D at T2-T5 were significantly lower than in group C, with statistical significance （P〈0.05）. The levels of adrenaline and norepinephrine at T1-T5 were significantly lower than group C, with statistical significance （P〈0.05）. CONCLU- SIONS： Adjunctive general anesthesia of dexmedetomidline can improve cardiac and cerebral ischemia-perfusion injury to certain extent.