右美托咪定在体外循环下心内直视手术患儿肺保护、心肌保护的作用及对应激反应的影响

Effects of Dexmedetomidine on Pulmonary Protection,Myocardial Protection and Stress Response in Children Undergoing Cardiopulmonary Bypass

目的:探讨右美托咪定对体外循环(CPB)下心内直视手术患儿肺保护、心肌保护的作用及对应激反应的影响。方法:选取2017年3月~2019年9月期间我院收治的CPB下行室间隔缺损修补术患儿80例,上述患儿根据随机数字表法分为对照组(n=40)和研究组(n=40),麻醉诱导后研究组给予右美托咪定维持至术毕,对照组给予等容量生理盐水。比较两组患儿麻醉诱导前(T1)、停机后6h(T2)、停机后24h(T3)的肺功能[呼吸指数(RI)、氧合指数(OI)和肺顺应性(CL)]、心肌功能[心肌肌钙蛋白I(cTnI)、缺铁修饰白蛋白(IMA)]、炎性因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)]及应激反应[皮质醇(Cor)、血糖(Glu)、去甲肾上腺素(NE)和肾上腺素(E)]情况。结果:两组T2~T3时间点RI呈下降趋势,且研究组低于对照组(P<0.05),两组T2~T3时间点OI、CL呈升高趋势,且研究组高于对照组(P<0.05)。两组T2~T3时间点cTnI、IMA呈下降趋势,且研究组低于对照组(P<0.05)。两组T2~T3时间点Cor、Glu、NE、E呈下降趋势,且研究组低于对照组(P<0.05)。两组T2~T3时间点IL-6、TNF-α、IL-1β呈下降趋势,且研究组低于对照组(P<0.05)。结论:CPB下心内直视手术患儿术中予以右美托咪定,可有效保护其肺功能、心肌功能,减轻机体应激反应及炎性刺激,有一定的临床应用价值。

Objective:To investigate the effect of dexmedetomidine on pulmonary protection,myocardial protection and stress response in children undergoing open heart surgery under cardiopulmonary bypass(CPB).Methods:80 children with ventricular septal defect repair by CPB who were admitted to our hospital from March 2017 to September 2019 were selected,children were divided into control group(n=40)and study group(n=40)according to the random number table method.After anesthesia induction,the study group was treated with dexmedetomidine until the end of operation,while the control group was treated with saline of equal volume.The pulmonary function[respiratory index(RI),oxygenation index(OI)and lung compliance(CL)],myocardial function[cardiac troponin I(cTnI),iron deficiency modifying protein(IMA)],inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)],and stress response[cortisol(Cor),blood glucose(Glu),noradrenaline(NE)and Adrenaline(E)]in the two groups before anesthesia induction(T1),6h after shutdown(T2)and 24h after shutdown(T3)were compared.Results:RI showed a decreasing trend at T2~T3 time points in both groups,and the study group was lower than the control group(P<0.05).OI and CL showed an increasing trend at T2~T3 time points in both groups,and the study group was higher than the control group(P<0.05).CTnI and IMA showed a decreasing trend in the two groups at T2~T3 time points,and the study group was lower than the control group(P<0.05).Cor,Glu,NE and E showed a decreasing trend in the two groups at T2~T3 time points,and the study group was lower than the control group(P<0.05).IL-6,TNF-αand IL-1βshowed a decreasing trend in both groups at T2~T3 time points,and the study group was lower than the control group(P<0.05).Conclusion:Dexmedetomidine in children with CPB undergoing open heart surgery can effectively protect their pulmonary function and myocardial function,reduce stress response and inflammatory stimulation,and which has a certain clinical application value.