右美托咪定对心脏手术患者术后认知功能的影响

Influence of Dexmedetomidine on Postoperative Cognitive Function of Patients after Cardiac Surgery

目的探讨右美托咪定对心脏手术患者术后认知功能的影响。方法选择2014年3月—2015年3月行体外循环心脏外科手术的64例患者作为研究对象,采用回顾性队列研究方法,根据是否在麻醉诱导前给予右美托咪定,分为右美托咪定组和非右美托咪定组,各32例。对比分析两组患者麻醉诱导后切皮前(T0)、体外循环开始后30 min(T1)、体外循环停止后30 min(T2)、手术结束时(T3)、手术结束后24 h(T4)、手术结束后72 h(T5)不同时间点平均动脉压(MAP)、心率(HR)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及IL-10水平差异,并评价患者术后的认知功能情况。结果 T1时右美托咪定组MAP和HR高于非右美托咪定组,且右美托咪定组T1时HR高于T0时(P<0.05)。T1~T3时右美托咪定组TNF-α低于非右美托咪定组(P<0.01);在T1~T4时右美托咪定组IL-6水平低于非右美托咪定组,IL-10水平高于非右美托咪定组(P<0.01)。术后3 d和7 d时右美托咪定组术后认知功能障碍发生率均明显低于非右美托咪定组(P<0.05)。结论右美托咪定在体外循环心脏外科手术中应用,可减少术后认知功能障碍的发生,可能与其抗炎作用有关。

Objective To investigate influence of Dexmedetomidine （DEX） on postoperative cognitive function of patients after cardiac surgery. Methods A total of 64 patients undergoing extracorporea] circulation of cardiac surgical procedures between March 2014 and March 2015 were recruited in this study, and the patients were divided into DEX group and no-DEX group （n --32 for each group） according to whether or not DEX administration before induction of an- esthesia by using retrospective cohort study method. Mean arterial blood pressure （MAP） , heart rate （HR） , tumor necrosis factor-α （TNF-α） , interleukin-6 （IL-6） and IL-10 levels at different time points after anesthesia induction and be- fore skin incision （T0） , at the 30th rain after extracorporeal circulation beginning （ T1 ） , at the 30th rain after extracorpo- real circulation ending （T2） , at the end of surgery （ T3 ） , at the 24th h after surgery ending （T4） and at the 72th h after surgery ending （TS） were compared, and postoperative conditions of cognitive function were evaluated in two groups. Re- suits At T1, MAP and HR levels in DEX group were significantly higher than those in no-DEX group, and HR level at T1 was higher than that at TO in DEX group （ P 〈 0.05）. TNF-α levels in T1 - T3 in DEX group were significantly lower than those in no-DEX group （P 〈0.01 ）. In T1 - T4, IL-6 levels were significantly lower, and IL-10 levels were signifi- cantly higher in DEX group than those in no-DEX group （P 〈 0.01 ）. At the postoperative 3rd and 7th d, incidence rate of postoperative cognition dysfunction in DEX group was significantly lower than that in no-DEX group （P 〈 0. 05 ）. Conclusion Dexmedetomidine in application of extracorporeal circulation of cardiac surgical procedures can reduce inci- dence rate of postoperative cognition dysfunction, and it may be related to its anti-inflammatory action.