右美托咪啶静脉泵注对CPB下瓣膜置换患者NAMPT、SACE的影响

Effects of intravenous infusion of dexmedetomidine on NAMPT and SACE in patients undergoing valve replacement under CPB

目的探讨右美托咪啶静脉泵注对心肺转流(cardio pulmonary bypass,CPB)下瓣膜置换患者血管紧张素转换酶(serum angiotensin converting enzyme,SACE)、尼克酰胺磷酸核糖转移酶(Nicotinamide phosphoribosyl transferase,NAMPT)的影响。方法选取择期进行CPB下心脏瓣膜置换术患者100例,按照数字随机表法分为对照组和观察组,每组50例。2组患者均使用相同麻醉诱导方法,进行瓣膜置换术,其中观察组患者在术中静脉泵注右美托咪定。分别在麻醉诱导后(T1)、CPB开始后30 min(T2)、CPB结束时(T3)、CPB结束后2 h(T4)检测2组患者TNF-α、IL-6水平、血糖、胰岛素和胰岛素敏感指数ISI、OI、RI、NAMPT、SACE水平以及不良反应发生情况。结果 T1时2组患者的TNF-α、IL-6水平差异无统计学意义(P> 0. 05),T2、T3、T4时两项指标水平均显著升高且观察组TNF-α、IL-6水平显著低于对照组(P <0. 05)。T1时2组患者血糖、胰岛素水平以及ISI差异无统计学意义(P> 0. 05),T2、T3时血糖、胰岛素水平均显著升高观察组显著高于对照组(P <0. 05),T2、T3时2组ISI显著下降观察组显著低于对照组(P <0. 05)。T1时间时2组患者的OI、RI水平以及NAMPT、SACE水平差异无统计学意义(P> 0. 05),T2、T3时间两组患者OI均显著降低,RI以及NAMPT、SACE水平显著升高(P <0. 05),观察组OI显著高于对照组,观察组R突以及NAMPT、SACE水平I显著低于对照组(P <0. 05)。2组患者均未出现低血压和心动过缓等不良反应。结论右美托咪啶静脉泵注对CPB下瓣膜置换患者,可有效抑制炎性反应,调节NAMPT、SACE水平,增加胰岛素敏感性,降低血糖,保护肺功能。

Objective To investigate the effects of dexmedetomidine intravenous injection on serum angiotensin converting enzyme(SACE)and nicotinamide phosphoribosyl transferase(NAMPT)in patients undergoing valve replacement under cardio pulmonary bypass(CPB).Methods A total of 100 patients who underwent valve replacement under CPB in our hospital from May 2015 to November 2016 were enrolled in the study.According to rondom number table method,these patients were divided into control group(n=50)and observation group(n=50).The patients in both groups were treated by the same method of anesthesia induction to perform valve replacement surgery,moreover,the patients in observation group were treated by intravenous injection with dexmedetomidine during operation.The levels of TNF-α,IL-6,blood glucose,insulin and insulin sensitivity indexes including ISI,OI,RI,NAMPT,SACE were etected after anesthesia induction(T1),30 minutes after CPB(T2),at the end of CPB(T3),2 hours after CPB,moreover and the incidence rates of adverse reactions were observed and compared between two groups.Results There were no significant differences in the levels of TNF-αand IL-6 at T1 between the two groups(P>0.05),however,which at T2,T3,T4 were significantly increased in both groups(P<0.05),moreover,which in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in the levels of blood glucose,insulin and ISI at T1 between the two groups(P>0.05),however,the levels of blood glucose and insulin at T2,T3 were significantly increased in both groups,and the levels of ISI were significantly decreased in both groups(P<0.05),moreover,the increase or decrease extent in observation group was more significantly than that in control group(P<0.05).There were no significant differences in the levels of OI,RI,NAMPT,SACEat T1 between the two groups(P>0.05),however,the levels of OI at T2 and T3 were significantly decreased in both groups(P<0.05),and the levels of RI,NAMPT,SACE were significantly increased,moreover,the increase or decrease extent in observation group was more significantly than that in control group(P<0.05).No adverse reactions including hypotension and bradycardia were observed in both groups.Conclusion Dexmedetomidine intravenous injection for the patients undergoing valve replacement under CPB can effectively inhibit the inflammatory response,regulate the levels of NAMPT,SACE,increase insulin sensitivity,decrease blood sugar levels and protect lung function of patients.