右美托咪定对非体外循环冠脉搭桥术患者脑功能和炎性反应的效果评价

Effect of dexmedetomidine on brain function and inflammatory responses in patients undergoing off-pump coronary artery bypass grafting

目的探讨右美托咪定对非体外循环冠脉搭桥术患者脑功能和炎性反应的影响。方法选取2017至2019年行非体外循环冠脉搭桥术患者40例,采用随机数字表法分为对照组(C)组和试验组(D组)。D组患者给予输注右美托咪定,C组患者给予等容量的0.9%氯化钠注射液。比较2组患者相关脑功能指标、炎性因子以及临床疗效情况。结果D组在T2、T3、T4时间点的血清S-100β蛋白和NSE蛋白水平均明显低于C组(P<0.05);与C组相比,D组在T2、T3时间点的颈静脉球部血氧饱和度SjvO2水平升高,而AVDO2、脑氧摄取率[CE(O2)]水平明显降低(P<0.05);D组中IL-1β、IL-6水平在T2时明显减低(P<0.05),TNF-α水平在T2、T3时均明显减低(P<0.05);HMGB-1水平在T2、T3、T4时均减低(P<0.05),而IL-10水平在T2时D组明显高于C组(P<0.05);通过MOCA和MMSE评分可知,D组患者出现认知功能障碍明显减低,并且在术后恢复认知能力更快(P<0.05);应用Dex的患者在术后通气维持时间、麻醉苏醒时间、住院时间明显低于C组(P<0.05)。结论右美托咪定有助于改善非体外循环冠脉搭桥术患者炎性反应,保护脑功能。

Objective To investigate the effect of dexmedetomidine(Dex)on brain function and inflammatory response in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of 40 patients who underwent OPCABG from 2017 to 2019 were randomly assigned in a 1∶1 ratio to receive Dex infusion(the group D)or equal volume of 0.9%sodium chloride injection(the group C).Brain function indexes,inflammatory factors and clinical efficacy were compared between groups.Results The serum S100βand neuron-specific enolase(NSE)proteins in the group D at the time points of T2,T3 and T4 were significantly lower than those of the group C(all P<0.05).Compared with those of the group C,jugular venous oxygen saturation(SjvO2)levels in the group D significantly increased at T2 and T3,while arterio-jugular differences of oxygen(AVDO2)and Cerebral extra ction of oxygen[CE(O2)]levels decreased significantly(all P<0.05).IL-1βand IL-6 levels in the group D significantly decreased at T2(both P<0.05),and TNF-αlevels significantly decreased at T2 and T3(both P<0.05).HMGB-1 levels were significantly reduced at T2,T3,and T4(all P<0.05),while IL-10 levels were significantly higher in the group D than those of the group C at T2(P<0.05).According to the Montreal cognitive assessment(MoCA)and the mini-mental state examination(MMSE)scores,the cognitive dysfunction was significantly relieved in the group D,and cognitive recovery was faster after surgery(both P<0.05).The postoperative ventilation maintenance time,anesthesia recovery time and hospitalization time of the group D were significantly lower than those of the group C(all P<0.05).Conclusion Dex can alleviate the inflammatory response and protect brain function in patients undergoing OPCABG.