心脏瓣膜置换术中右美托咪定对认知功能的保护价值及对炎症因子、POCD的影响

Protective Effect of Dexmedetomidine on Cognitive Function and Its Influence on Inflammatory Factors and POCD during Cardiac Valve Replacement

目的:探讨心脏瓣膜置换术中右美托咪定对认知功能的保护价值及对炎症因子、术后认知功能障碍(POCD)的影响。方法:选择2017年1月-2019年10月三河市中医医院收治的310例心脏瓣膜置换术患者,按照入院顺序编号,随机数字表法分为试验组和对照组,每组155例。试验组麻醉诱导前静脉滴注右美托咪定0.5~1.0μg/kg,持续10~15 min,对照组麻醉诱导前给予相同量生理盐水。比较两组平均动脉压、心率、炎症因子、脂肪酸结合蛋白、认知功能评分、认知功能障碍发生率及不良反应事件等。结果:试验组T_(1)~T_(5)不同时间点心率均明显低于对照组,平均动脉压均明显高于对照组(P<0.05)。试验组术后3、7 d血清TNF-α和IL-6、H-FABP和B-FABP水平均明显低于对照组(P<0.05);两组术后3 d血清TNF-α、IL-6、H-FABP和B-FABP水平的明显高于麻醉诱导前和术后7 d(P<0.05),且两组术后7 d血清TNF-α、IL-6、H-FABP和B-FABP的明显高于麻醉诱导前(P<0.05);两组术后3、7 d的MoCA评分均低于麻醉诱导前,两组术后7 d的MoCA评分均高于术后3 d,且试验组术后3、7 d的MoCA评分均高于对照组(P<0.05)。术后3 d,试验组POCD发生率为15.48%(24/155),明显低于对照组的32.90%(51/155)(P<0.05);术后7 d,试验组POCD发生率为8.39%(13/155),明显低于对照组的20.00%(31/155)(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在麻醉诱导前静脉滴注右美托咪定可在一定程度上降低心脏瓣膜置换术诱发的炎症反应,降低POCD发生率。

Objective:To study the protective effect of Dexmedetomidine on cognitive function and its influence on inflammatory factors and postoperative cognitive dysfunction(POCD)during cardiac valve replacement.Method:A total of 310 patients underwent cardiac valve replacement from January 2017 to October 2019 were selected.According to the sequence of admission,the patients were randomly divided into the experimental group(n=155)and the control group(n=155).The experimental group was given Dexmedetomidine 0.5-1.0μg/kg,intravenously for 10-15 minutes before anesthesia induction,while the control group was given the same amount of Normal Saline before anesthesia induction.The mean arterial pressure,heart rate,inflammatory factors,cognitive function score,fatty acid binding protein and the incidence of cognitive impairment of two groups were compared.Result:The heart rate of the experimental groups at different time points from T_(1) to T_(5) were significantly lower than those of the control group,and the mean arterial pressure were significantly higher than those of control group(P<0.05).The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),central fatty acid binding protein(H-FABP)and brain fatty acid binding protein(B-FABP)in the experimental group at 3 and 7 d after surgery were significantly lower than those in the control group(P<0.05).The levels of serum TNF-α,IL-6,H-FABP and B-FABP in two groups at 3 d after surgery were significantly higher than those before anesthesia induction and 7 d after surgery(P<0.05),and the levels of serum TNF-α,IL-6,H-FABP and B-FABP in two groups at 7 d after surgery were significantly higher than those before anesthesia induction(P<0.05).The MoCA scores of two groups at 3 and 7 d after surgery were lower than those before anesthesia induction,the MoCA scores of two groups at 7 d after surgery were higher than those at 3 and 7 d after surgery,and the MoCA scores of the experimental group at 3 and 7 days after surgery were higher than those of the control group(P<0.05).The incidence of POCD in the experimental group on the 3rd day after operation was 15.48%(24/155),which was significantly lower than 32.90%(51/155)in the control group(P<0.05);while the incidence of POCD in the experimental group on the 7th day after operation was 8.39%(13/155),which was significantly lower than 20.00%(31/155)in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion:Intravenous infusion of Dexmedetomidine before induction of anesthesia can reduce the inflammatory response induced by cardiac valve replacement to a certain extent and reduce the incidence of POCD.