右美托咪定对老年患者体外循环心肌缺血再灌注损伤的保护作用

Protective effect of dexmedetomidine on myocardial ischemia-reperfusion injury in elderly patients during cardiopulmonary bypass

目的观察右美托咪定对体外循环(CPB)下老年患者心肌缺血再灌注损伤的影响。方法 60例择期体外循环下脉瓣膜置换术的老年患者随机分为试验组30例和对照组30例。气管插管后,对照组恒速输注等量0.9%Na Cl,试验组恒速输注右美托咪定0.5μg·kg^(-1)·h^(-1)。分别于麻醉诱导前(T_0),主动脉开放后15 min(T_1),停机即刻(T_2),停机后8 h(T_3),术后24 h(T_4)采集颈内静脉血样,测定血清超氧化物歧化酶(SOD)、一氧化氮(NO)、丙二醛(MDA)、心肌肌钙蛋白I(c T_n-I)、肌酸激酶同工酶(CK-MB)及肿瘤坏死因子-α(T_NF-α)的变化,并记录术后恶心、寒战及谵妄的发生情况。结果试验组T_2~T_4的血清MDA分别为(19.67±2.05),(25.11±2.82),(21.48±2.02)μmol·L^(-1),对照组T_2~T_4的血清MDA分别为(27.56±2.24),(34.44±2.03),(28.19±2.38)μmol·L^(-1)。试验组T_2~T_4的c T_n-I分别为(3.82±0.38),(3.12±0.30),(2.28±0.31)μg·L^(-1);对照组T_2~T_4的c T_n-I分别为(5.24±0.43),(4.01±0.32),(3.45±0.29)μg·L^(-1)。试验组T_2~T_4的CK-MB分别为(29.98±4.01),(22.73±2.66),(17.64±2.81)U·L^(-1),对照组T_2~T_4的CK-MB分别为(41.07±5.68),(31.44±2.82),(24.55±3.78)U·L^(-1)。试验组T_2~T_4的T_NF-α分别为(121.61±16.52),(209.63±32.11),(111.98±15.32)pg·m L^(-1);对照组T_2~T_4的T_NF-α分别为(154.92±18.34),(261.89±35.49),(137.09±19.66)pg·m L^(-1)。试验组T_2~T_4的SOD分别为(73.29±6.81),(71.52±6.18),(79.77±6.23)U·m L^(-1),对照组T_2~T_4的SOD分别为(56.98±6.47),(52.45±6.09),(64.58±6.39)U·m L^(-1)。试验组T_2~T_4的NO分别为(24.81±3.99),(27.21±4.07),(40.62±4.72)μmol·L^(-1);对照组T_2~T_4的NO分别为(17.25±3.25),(19.74±3.08),(28.69±3.47)μmol·L^(-1)。试验组T_2~T_4时刻,患者血清MDA、c T_n-I、CK-MB、T_NF-α、SOD及NO含量与对照组比较,差异均有统计学意义(P<0.05)。2组恶心、谵妄的发生率差异无统计学意义(P>0.05)。试验组术后寒战的发生率为6.67%(2/30例),对照组为26.67%(8/30例),差异有统计学意义(P<0.05)。结论麻醉期间静脉滴注右美托咪定0.5μg·kg^(-1)·h-1可以减轻老年患者体外循环下心肌缺血再灌注损伤。

Objective To observe the clinical effect of dexmedetomidine on myocardial ischemia - reperfusion injury of senior patients with valve replacement during cardiopulmonary bypass. Methods Sixty patients were randomly divided into control group and treatment group, thirty patients in each group. Dexmedetomidine 0. 5 μg · kg^-1 · h^-1 was intravenously injected by infusing pump after tracheal intubation in treatment group ,while patients in control group were administered with an equal volume of 0. 9% NaCl. Blood samples were collected from jugular vein before induction of anesthesia （T0 ）, at 15 rain after aortic declamping （ T1 ）, end of cardiopulmonary bypass （ CPB, T2 ）, 8 h after CPB （ T3 ）, 24 h after operation （T4 ）. The levels of serum superoxide （SOl））, nitric oxide （NO）, malondialdehyde （MDA）, cardiac troponin I （eTn -I）, creatine kinase （ CK - MB） and tumor necrosis factor （ TNF - α） were recorded. And postoperative adverse drug reactions including nausea, chill and delirium were observed. Results The levels of serum MDA were （ 19.67 ± 2.05 ） , （25.11 ± 2.82）, （21.48±2.02）μmol·L^-1in treatment group and （27.56 ±2.24）, （34.44 ±2.03）, （28. 19 ±2.38） μmol·L^-1 in control group at T2 -T4. The levels of serum cTn -I were （3.82 ±0. 38）, （3.12 ±0. 30）, （2. 28 ± 0. 31 ） μg · L^-1 in treatment group and （5.24 ±0. 43）, （4. 01 ±0. 32）, （3.45 ±0. 29） μg · L^-1 in control group at T2 - T4. The levels of serum CK - MB were （29.98 ±4. 01 ）, （22. 73 ±2. 66）, （ 17.64 ±2. 81 ） U · L^-1 in treatment group and （41.07 ±5.68）, （31.44 ±2.82）, （24.55 ±3.78） U · L^-1 in control group at T2 -T4. The levels of serum TNF-α were （121.61 ± 16.52）, （209.63 ±32. 11 ）, （111.98 ± 15.32） pg · mL^-1 in treatment group and （ 154. 92 ± 18.34）, （261.89 ± 35.49）, （ 137.09 ± 19. 66） pg · mL^-1 in control group at T2 - T4. The levels of serum SOD were （73.29 ± 6.81 ）, （71.52 ± 6. 18 ）, （ 79.77 ± 6. 23 ） U · mL^-1 in treatment group and （ 56.98 ± 6. 47）, （52. 45 ± 6, 09）, （64. 58 ± 6. 39） U · mL^-1 in control group at T2 -T4. The levels of serum NO were （24.81 ±3.99）, （27.21 ±4.07）, （40.62 ± 4.72） μmol · L^-1 in treatment group and （17.25 ± 3.25）, （ 19.74 ± 3.08） , （ 28.69 ± 3.47 ） μmol · L^- 1 in control group at T2 - T4. The levels of serum MDA, eTn - I, CK - MB, TNF - α, SOD and NO at T2 - T4 in treatment group had significant difference compared with control group （P 〈 0. 05 ）. There was no significant difference on the incidence of nausea and delirium between two groups. The incidence of chill declined in treatment group was 6. 67% （2/30）, had significant difference with 26. 67% （8/30） in control group （P 〈 0. 05 ）. Conclusion Intravenous injection of dexmedetomidine 0. 5 μg · kg^-1 · h^- 1 during general anesthesia can reduce myocardium isehemia -reperfusion in elderly patients undergoing eardiopulmonary bypass.