右美托咪定在心脏瓣膜置换术中对凝血功能的影响

Effect of dexmedetomidine on coagulation function in heart valve replacement surgery

目的评价右美托咪定在心脏瓣膜置换术中对凝血功能的影响。方法选取该院2020年1-12月择期拟在全身麻醉下行心脏瓣膜置换术的患者60例,分为对照组(C组)和右美托咪定组(D组),每组30例。D组在麻醉诱导后经静脉10 min泵注右美托咪定1μg/kg,之后以0.5μg·kg^(-1)·h^(-1)的速率泵注至手术结束,C组给予等容量的生理盐水。分别于手术前(T_(0))、术毕(T_(1))、术后6 h(T_(2))时检测凝血酶原时间(PT)、血小板计数(PLT)、血浆纤维蛋白降解产物(FDP)水平,血栓弹力图(TEG)检测凝血反应时间(R)、凝血形成时间(K)、凝固角(α-Angle)、最大振幅(MA)、LY30,ELISA测定血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)水平,记录患者术后严重意外事件和并发症发生情况。结果与T_(0)时比较,C组T_(1)、T_(2)时PT、R、K、LY30增加,FDP、IL-6、IL-10和TNF-α水平升高,PLT、α-Angle、MA减小,差异有统计学意义(P<0.05);D组T_(1)、T_(2)时PLT、MA减小,FDP、IL-6、IL-10和TNF-α水平升高,LY30增加,T_(1)时PT、R、K增加,差异有统计学意义(P<0.05)。与C组比较,D组T_(1)、T_(2)时PT、R、LY30减少,FDP、IL-6、TNF-α水平降低,IL-10水平升高,T_(1)时α-Angle增加,差异有统计学意义(P<0.05)。结论右美托咪定在体外循环下的瓣膜置换手术中对凝血功能有一定的改善作用,其机制可能与抑制炎性反应、减少炎症介质产生有关。

Objective To evaluate the effect of dexmedetomidine on the coagulation function of the patients with heart valve replacement surgery.Methods Sixty patients with elective heart valve replacement surgery under the general anesthesia in this hospital from January to December 2020 were selected and divided into the control group(group C)and dexmedetomidine group(group D),30 cases in each group.The group D was intravenously pumped by 1μg/kg of dexmedetomidine for 10 min after anesthesia induction,and then pumped at a rate of 0.5μg·kg^(-1)·h^(-1) until the end of the surgery.The group C was given the same volume of normal saline.The levels of prothrombin time(PT),platelet count(PLT)and plasma fibrin degradation product(FDP)were detected before anesthesia induction(T_(0)),after surgery(T_(1))and at postoperative 6 h(T_(2)).Thromboelastography(TEG)was used to detect the R value,K time,α-Angle,maximum amplitude(MA)and LY30.The levels of serum interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor alpha(TNF-α)were measured by enzyme-linked immunosorbent assay(ELISA).The occurrence of serious accidents and complications after surgery were recorded.Results Compared with at T0,the levels of PT,R,K and LY30 at T_(1) and T_(2) in the group C were increased,the levels of FDP,IL-6,IL-10 and TNF-αwere elevated,the levels of PLT,α-Angle and MA were decreased,and the differences were statistically significant(P<0.05).The PLT and MA at T_(1) and T_(2) in the group D were decreased,the levels of FDP,IL-6,IL-10 and TNF-αwere increased,the LY30 level was increased,the levels of PT,R and K at T_(1) was increased,and the differences were statistically significant(P<0.05);compared with the group C,the levels of PT,R and LY30 at T_(1) and T_(2) in the group D were decreased,the levels of FDP,IL-6 and TNF-αwere reduced,the IL-10 level was increased,theα-Angle at T_(1) was increased,and the differences were statistically significant(P<0.05).Conclusion Dexmedetomidine has a certain effect for improving the coagulation function in heart valve replacement surgery under general anesthesia,its mechanism may be related with inhibiting the inflammatory reaction and decreasing the inflammatory mediators.