右美托咪定对心脏瓣膜置换术者认知功能影响

Effect of dexmedetomidine on postoperative cognitive function in patients with heart valve replacement surgery

目的 探讨右美托咪定（DEX）对心脏瓣膜置换术患者术后认知功能影响。方法 择期行心脏瓣膜置换术患者90例,采用随机、双盲方法将患者分3组,分别是对照组（n=30）、DEX0.3μg/kg组（n=30）、DEX0.6μg/kg组（n=30）。DEX0.3、0.6μg/kg组在气管插管成功后分别10min内静脉泵入DEX0.3、0.6μg/kg,随后分别以0.3μg/kg/h及0.6μg/kg/h持续输注至关胸,对照组泵入等容生理盐水。于麻醉诱导前（T0）、术毕（T1）、术后第3天（T2）、术后第7天（T3）抽中心静脉血测血清C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白介素-6（IL-6）、神经元特异性烯醇化酶（NSE）及S100B蛋白（S100b）含量;分别用简易精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）于手术前1d、T2、T3进行认知功能检测。结果 与T0比较,TNF-α、IL-6、S100b在T1时升高,NSE在T1~2时升高,CRP在T2~3时升高（P〈0.05）;与对照组比较,DEX0.3、0.6μg/kg组在T1时TNF-α、IL-6、S100b均减少;DEX0.6μg/kg组在T1~2时NSE减少,在T2~3时CRP减少（P〈0.05）;与DEX0.3μg/kg组比较,DEX0.6μg/kg组在T1时TNF-α、IL-6、S100b均减少,在T1~2时NSE减少,在T2时CRP减少（P〈0.05）;与手术前1d比较,MMSE和MoCA测试3组患者得分在T2~3时均降低（P〈0.05）。结论 DEX可改善心脏瓣膜置换术患者术后认知功能,尤以DEX0.6μg/kg组效果最佳,可能与其神经保护及抑制炎症反应功能有关。

Objective To discuss the effect of dexmedetomidine（DEX） on postoperative cognitive function Ⅲ patients with heart valve replacement surgery. Methods 90 patients scheduled for heart valve replacement in randomized, double-blind were divided into 3 groups ： the control group （ n = 30） , given DEX 0.3 μg/kg group （ n = 30）, given DEX 0.6 μg/kg group（n =30）. Given DEX 0.3 μg/kg or 0.6 μg/kg group after tracheal intubation were respectively administrated with DEX 0. 3 μg/kg or 0. 6 μg/kg in the infusion time of 10 rain, followed respectively infusion of 0. 3 μg/（ kg · h） or 0. 6μg/（ kg·h） DEX to closed chest. The control group gave the same volume of saline. Central venous blood was drawn to measure respectively C-reactive protein（CRP） , tumor necrosis factor-α （ TNF-α）, interleukin-6 （ IL-6 ）, neuron-specific enolase （ NSE）, S100B protein （S100-b） before anesthe- sia induction （ T0 ）, postoperative （ T1 ）, 3 day post-operation （ T2 ）, 7 day post-operation （ T3 ）. The cognitive function of patients in three groups was evaluated respectively by mini-mental state examination （MMSE） and montreal cognitive assessment（MoCA） at 1 day pre-operation, T2 and T3. Results Compared with T0,TNF-α, IL-6, S100- b value increased in the T1 time points, NSE value increased in the T1-2 time points, CRP value increased in the T2-3 time points（P 〈0. 05）. Compared with the control group, TNF-ct,IL-6,SI00-b value of given DEX 0.3 μg/ kg or 0. 6 μg/kg group reduced in the T1 time points, NSE value of given DEX 0. 6 μg/kg group reduced in the T1-2 time points, CRP value of given DEX 0. 6 μg/kg group reduced in the T2-3 time points （P 〈0.05）. Compared with given DEX 0. 3 μg/kg group, TNF-α, IL-6, S100-b value of given DEX 0. 6 μg/kg group reduced in the T1 time points, NSE value of given DEX 0.6 μg/kg group reduced in the T1-2 time points, CRP value of given DEX 0. 6 μg/kg group reduced in the T2 time points （P 〈 0. 05）. Compared with 1 day pre-operation, score of patients in three groups reduced in the T2-3 time points by MMSE and MoCA（P 〈0. 05）. Conclusion DEX for patients with heart valve replacement surgery can improve the postoperative cognitive function, especially given DEX 0. 6 μg/kg group effectively. It is probably connected with nerve protective effect and inhibiting inflammatory reaction of DEX.