右美托咪定对心脏瓣膜置换术患者的心脑保护作用

Protective effect of Dexmetomidine on heart and brain in patients undergoing cardiac valve replacement

目的探讨右美托咪定对心脏瓣膜置换术患者的心脑保护作用.方法以2014年7月至2016年10月在我院接受心脏瓣膜置换术的62例患者为研究对象,平均分为观察组(31例)和对照组(31例).观察组在麻醉诱导基础上静注右美托咪定(1.0 μg/kg).对照组静注等量生理盐水.比较两组围手术期数据,抽取中心静脉血酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)法检测不同时间点的心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)、磷酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、心肌肌钙蛋白Ⅰ(cardiac Troponin Ⅰ,cTnI),血氧分压(partial pressure of blood oxygen,PaO2)、颈内静脉氧饱和度(internal jugular vein oxygen saturation,SjvO2)、氧摄取率(oxygen uptake rate,O2ER)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、脑动-颈内静脉血氧含量差(difference of blood oxygen content be-tween cerebral artery and internal jugular vein,Ca-jvO2)、S-100β蛋白(S-100β protein,S-100β).结果在T2、T3、T4、T6时间点,两组PaO2[对照组(133.28±52.49)mmHg、(233.29±46.21)mmHg、(186.13±34.82)mmHg和(222.63±52.75) mm Hg,观察组(132.99±67.72)mm Hg、(210.72±35.60)mm Hg、(156.73±37.02)mm Hg和(201.62±50.92) mm Hg]、SjvO2[对照组(66.42±6.84)%、(81.81±8.04)%、(72.42±7.35)%和(69.02±7.42)%,观察组(65.13±7.23)%、(71.67±9.22)%、(68.84±6.29)%和(63.51 ±6.23)%]、O2ER[对照组(37.18±7.87)%、(26.62±7.65)%、(36.01±8.29)%和(43.04±7.31)%,观察组(36.66±6.33)%、(19.05±9.32)%、(28.28±7.41)%和(39.50±8.05)%]、NSE[对照组(6.16±1.29)μg/L、(19.58±4.18)μg/L、(22.97±4.61)μg/L和(26.38±4.29)μg/L,观察组(6.27±1.13)μg/L、(17.36±3.49)μg/L、(20.66±4.21)μg/L和(23.76±4.31)μg/L]、S-100β[对照组(0.14±0.02)μg/L、(4.50±1.37)μg/L、(5.49±1.27)μg/L和(6.86±1.71)μg/L,观察组(0.13±0.02)μg/L、(3.88±1.34)μg/L、(4.03±1.97)μg/L和(6.02±1.55)μg/L]和Ca-jvO2[对照组(50.14±7.64)ml/L、(33.62±6.42)ml/L、(56.21±6.36)ml/L和(53.62±7.83)ml/L,观察组(49.31±8.08)ml/L、(24.72±7.48)ml/L、(43.62±8.26)ml/L和(46.23±7.19)ml/L]比较差异有统计学意义(P<0.05).在T1、T5、T6、T7、T8时间点,两组H-FABP[对照组(0.27±0.03)μg/ml、(0.59±0.16)μg/ml、(1.95±0.24)μg/ml、(2.39±0.42)μg/ml和(1.58±0.21)μg/ml,观察组(0.26±0.04)μg/ml、(0.46±0.09)μg/ml、(1.72±0.14)μg/ml、(1.90±0.12)μg/ml和(1.43±0.16)μg/ml]、CK-MB[对照组(22.28±4.28)U/ml、(67.31±15.74)U/ml、(139.66±4.34)U/ml、(156.17±40.14)U/ml和(116.37±18.41)U/ml,观察组(21.96±4.71)U/ml、(63.62± 13.40) U/ml、(120.25±8.46) U/ml、(134.71±36.69) U/ml和(89.61±15.48)U/ml]和cTnI[对照组(0.32±0.05)ng/ml、(0.79±0.23) ng/ml、(1.22±0.12)ng/ml、(1.77±0.24) ng/ml和(1.50±0.18)ng/ml,观察组(0.3 1±0.04)ng/ml、(0.68±0.20) ng/ml、(0.92±0.04) ng/ml、(1.37±0.15) ng/ml和(1.16±0.21)ng/ml]比较差异有统计学意义(P<0.05).结论心脏瓣膜置换术时应用右美托咪定有助于下调SjvO2、O2ER、NSE、S-100β、Ca-jvO2、H-FABP、cTnI蛋白表达,上调PaO2、CK-MB蛋白表达,从而起到心肌保护和脑保护作用.

Objective To investigate the cardio-cerebral protective effect of Dexmetomidine on patients undergoing cardiac valve replacement. Methods From July 2014 to October 2016, 62 patients underwent cardiac valve replacement in our hospital. The patients were divided into two groups: observation group (n=31) and control group (n=31). On the basis of anesthesia induction, Dexmetidine was injected intravenously in the observation group (1.0 μg/kg). The control group was given the same amount of saline. The perioperative data of the two groups were compared. The heart-type fatty acid binding protein ( H-FABP), creatine kinase isoenzyme (CKMB), cardiac troponin 1( cTnI). partial pressure of blood oxygen( PaO2), internal jugular vein oxygen saturation (SjvO2). oxygen uptake rate( O2ER), neuron-specific enolase(NSE). difference of blood oxygen content between cerebral artery and internal jugular vein (Ca-jvO2), S-100β protein (S-100β) were measured by central venous blood enzyme-linked immunosorbent assay (ELISA) method at different time points. Results At the time of T2, T3,T4 and T6. PaO2[the control group(133.28±52.49)mm Hg,(233.29±46.21)mm Hg,(186.13±34.82)mm Hg and (222.63±52.75)mm Hg,observation group(132.99±67.72)mm Hg,(210.72±35.60)mm Hg,( 156.73±37.02) mm Hg and (201.62±50.92)mm Hg j. SjvO2[the control group(66.42±6.84)%,(81.81±8.04)%,(72.42±7.35)% and (69.02±7.42)%, observation group(65.13±7.23)%,(71.67±9.22)%,(68.84±6.29)% and (63.51±6.23)%], O2ER[the control group( 37.18±7.87)%,(26.62±7.65)%,(36.01±8.29)% and (43.04±7.31)%, observation group (36.66±6.33)%,(19.05±9.32)%,(28.28±7.41)% and (39.50±8.05)%],NSE[the control group(6.16±1.29)μ/L,(19.58±4.18)μg/L,(22.97±4.61)μg/L and (26.38±4.29)μg/L, observation group(6.27±1.13)μg/L,(17.36±3.49)μg/L,(20.66±4.21)μg/L and (23.76±4.31)μg/L, S-100β[the control group(0.14±0.02)μg/L,(4.50±1.37)μg/L,(5.49±1.27)μg/L and (6.86±1.71)μg/L, observation group(0.13±0.02)μg/L,(3.88±1.34)μg/L,(4.03±1.97)μg/L and (6.02±1.55)μg/L] and Ca-jvO2[the control group(50.14±7.64)ml/L,(33.62±6.42)ml/L,(56.21±6.364)ml/L and (53.62±7.83)ml/L, observation group(49.31±8.08)ml/L.(24.72±7.48)ml/L,(43.62±8.26)ml/L and (46.23±7.I9)ml/L were significantly (P<0.05). At the time of T1, T2, T3, T7 and T8, H-FABP [the control group(0.27±0.03)μg/ml,(0.59±0.16)μg/ml,(1.95±0.24)μg/ml,(2.39±0.42)μg/ml and (1.58±0.21)μg/ml, observation group(0.26±0.04)μg/ml,(0.46±0.09)μg/ml,(1.72±0.14)μg/ml,( 1.90±0.12)μg/ml and (1.43±0.16)μg/ml], CK-MB[the control group(22.28±4.28)U/ml,(67.31±15.74)U/ml,(139.66±4.34)U/ml,(156.17±40.14)U/ml and (116.37±18.41)U/ml. observation group(21.96±4.71)U/ml.(63.62±13.40)U/ml,(120.25±8.46) U/ml,(134.71±36.69)U/ml and (89.61±15.48)U/ml and cTnli the control group(0.32±0.05)ng/ml,(0.79±0.23) ng/ml,(1.22±0.12)ng/ml,(1.77±0.24)ng/ml and ( 1.50±0.18)ng/ml, observation group(0.31±0.04)ng/ml,(0.68±0.20)ng/ml,(0.92±0.04)ng/ml,(1.37±0.15)ng/ml and (1.16±0.21)ng/ml] were significantly (P<0.05). Conclusion Dcxmetomidine can down-regulate the expression of SjvO2, O2ER. NSE, S-100β, Ca-jvO2, H-FABP. cTnl protein and up-rcgulate the expression of PaO2, CK-MB protein thus play a role in protective myo cardium and brain during the operation of cardiac valve replacement.