右美托咪定对冠状动脉旁路移植术患者红细胞功能的影响

Effect of dexmedetomidine on erythrocyte function in patients undergoing coronary artery bypass grafting

目的探讨手术前后右美托咪定应用对非体外循环冠状动脉旁路移植术患者红细胞糖代谢和脂质过氧化的影响。方法选取2017年11月至2018年5月该院收治的拟行非体外循环冠状动脉旁路移植术患者60例,采用随机数字表法分为观察组和对照组,每组30例。观察组麻醉诱导前给予右美托咪定负荷量(0.5~1.0μg/kg,15 min),维持量为0.3~0.5μg/(kg·h)至手术结束,术后镇痛采用舒芬太尼2.0μg/kg联合右美托咪定4.0μg/kg,均用生理盐水稀释至100 mL,输注速率为2 mL/h。对照组麻醉诱导前注入相同剂量生理盐水,术后镇痛采用舒芬太尼2.0μg/kg。分别于麻醉诱导前(T 1)、手术结束(T 2)、术后12 h(T 3)、术后24 h(T 4)、术后48 h(T 5)检测2组患者血糖,以及红细胞磷酸果糖激酶(PFK)、葡萄糖-6-磷酸脱氢酶(G-6PD)、醛糖还原酶(AR)、过氧化脂质(LPO)、谷胱甘肽(GSH)等。结果与T 1时比较,2组患者T 3、T 4时血糖及红细胞G-6PD、AR、LPO均明显升高,红细胞PFK、GSH均明显降低,差异均有统计学意义(P<0.05)。观察组患者T 3、T 4时血糖及红细胞G-6PD、AR、LPO均较对照组明显降低,红细胞PFK、GSH均较对照组升高,术后苏醒时间、机械通气时间均明显短于对照组,差异均有统计学意义(P<0.05)。结论手术前后应用右美托咪定可促使冠状动脉旁路移植术患者术后红细胞糖代谢功能改善,提高机体抗氧化能力。

Objective To investigate the effect of intraoperative and postoperative dexmedetomidine use on erythrocyte glucose metabolism and lipid peroxidation in the patients undergoing coronary artery bypass grafting under non-extracorporeal circulation.Methods Sixty patients undergoing coronary artery bypass grafting under non-extracorporeal circulation in the hospital from November 2017 to May 2018 were selected and divided into the observation group and control by adopting the random number table method,30 cases in each group.The observation group was given the load dose of dexmedetomidine(0.5-1.0μg/kg,15 min)before anesthesia induction,the maintain dose was 0.3-0.5μg/(kg·h)until the end of the operation.The postoperative analgesia adopted sufentanil 2.0μg/kg combined with dexmedetomidine 4.0μg/kg,which were diluted to 100 mL by normal saline,with a infusion rate of 2 mL/h.The control group was infused with the same dose of normal saline before anesthesia induction.The postoperative analgesia adopted sufentanil 2.0μg/kg.The levels of blood glucose,erythrocyte phosphofructokinase(PFK),glucose-6-phosphate dehydrogenase(G-6PD),aldose reductase(AR),lipid peroxidation(LPO)and glutathione(GSH)were determined before anesthesia induction(T 1),operation end(T 2),at postoperative 12 h(T 3),24 h(T 4),48 h(T 5).Results Compared with those at T 1,the levels of blood glucose,erythrocyte G-6PD,AR and LPO at T 3 and T 4 in the two groups were significantly increased,and the levels of red blood cell PFK and GSH were significantly decreased,and the differences were statistically significant(P<0.05).The blood glucose,erythrocyte G-6PD,AR and LPO at T 3,T 4 in the observation group were significantly decreased compared with the control group(P<0.05),while erythrocyte PFK and GSH levels were increased,the postoperative recovery time and mechanical ventilation time were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Using dexmedetomidine before and after operation can promote the improvement of postoperative erythrocyte metabolic function and enhance the body antioxidant capacity in the patients with coronary artery bypass grafting.