右美托咪定联合舒芬太尼对心脏瓣膜置换术患者心肌损伤、应激反应及认知功能的影响

Effects of dexmedetomidine combined with sufentanil on myocardial injury,stress response and cognitive function in patients undergoing cardiac valve replacement

目的探讨右美托咪定联合舒芬太尼在心脏瓣膜置换术患者中的应用效果。方法将2020年9月至2021年3月我院收治的155例心脏瓣膜疾病患者随机分为对照组(77例)和观察组(78例),均行心脏瓣膜置换术,对照组术中采用舒芬太尼,观察组术中采用右美托咪定联合舒芬太尼。比较两组的心肌损伤指标、应激反应指标、认知功能。结果术前,两组的心脏型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(cTnI)水平比较,差异无统计学意义(P>0.05);术后6、24 h,观察组的H-FABP、CK-MB、cTnI水平低于对照组(P<0.05)。术前,两组的皮质醇(Cor)、肾上腺素(E)水平比较,差异无统计学意义(P>0.05);术后24 h,观察组的Cor、E水平低于对照组(P<0.05)。术前1 d,两组的简易精神状态量表(MMSE)评分比较,差异无统计学意义(P>0.05);术后1、7 d,观察组的MMSE评分高于对照组(P<0.05)。结论在心脏瓣膜置换术中采用右美托咪定联合舒芬太尼能取得较好的麻醉效果,可减轻心肌损伤及应激反应,减少对认知功能的影响。

Objective To investigate the application effect of dexmedetomidine combined with sufentanil in patients undergoing cardiac valve replacement.Methods A total of 155 patients with cardiac valve disease treated in our hospital from September 2020 to March 2021 were randomly divided into control group(77 cases)and observation group(78 cases).All patients underwent cardiac valve replacement.The control group was given sufentanil,and the observation group was given dexmedetomidine combined with sufentanil during operation.The myocardial injury indexes,stress response indexes and cognitive function were compared between the two groups.Results Before operation,there were no significant differences in the levels of heart-type fatty acid-binding proteins(H-FABP),creatine kinase-MB(CK-MB)and cardiac troponin I(cTnI)between the two groups(P>0.05);at 6 and 24 h after operation,the levels of H-FABP,CK-MB and cTnI in the observation group were lower than those in the control group(P<0.05).Before operation,there were no significant differences in the levels of cortisol(Cor)and epinephrine(E)between the two groups(P>0.05);at 24 h after operation,the levels of Cor and E in the observation group were lower than those in the control group(P<0.05).At 1 d before operation,there was no significant difference in mini-mental state examination(MMSE)score between the two groups(P>0.05);at 1 and 7 d after operation,the MMSE score of the observation group was higher than that of the control group(P<0.05).Conclusion Dexmedetomidine combined with sufentanil applied in cardiac valve replacement can achieve the better anesthetic effect,reduce the myocardial injury,stress response and the impact on cognitive function.