右美托咪定联合芬太尼对心脏瓣膜置换术患者细胞免疫功能的影响及心脑保护作用研究

Effect of Dexmedetomidine Combined with Fentanyl on Cellular Immune Function and Cardioprotective Effect Study in Patients Undergoing Heart Valve Replacement

目的:观察右美托咪定联合芬太尼对心脏瓣膜置换术患者细胞免疫功能的影响及在心脑保护中的作用。方法:纳入海南医学院第二附属医院2019年4月~2021年6月间接收的体外循环(CPB)下心脏瓣膜置换术患者97例,根据信封抽签法将患者分为对照组(芬太尼,48例)和观察组(右美托咪定联合芬太尼,49例)。对比两组血流动力学指标[平均动脉压(MAP)、心率(HR)]、心肌损伤指标[肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、心型脂肪酸结合蛋白(HFABP)]、脑损伤指标[神经元特异性烯醇化酶(NSE)、S-100β]、细胞免疫功能、镇痛情况及不良反应发生率。结果:观察组CPB开始后10 min(T2)时间点HR、MAP低于对照组,CPB结束(T3)、术毕(T4)时间点HR、MAP高于对照组(P<0.05)。两组术前(T1)、术后24 h、术后48 h视觉模拟评分法(VAS)评分升高后降低(P<0.05),观察组术后24 h、术后48 h VAS评分低于对照组(P<0.05)。观察组术后48 h CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05)。观察组术后48 h cTnI、CK-MB、HFABP低于对照组(P<0.05)。观察组术后48 h NSE、S100B低于对照组(P<0.05)。观察组的不良反应发生率低于对照组(P<0.05)。结论:心脏瓣膜置换术患者选用右美托咪定联合芬太尼麻醉方案,有助于减轻疼痛,稳定血流动力学,减轻免疫抑制,同时还可发挥心脑保护效果,降低不良反应发生率,是一种可靠的麻醉方案。

Objective:To observe the effect of dexmedetomidine combined with fentanyl on cellular immune function and cardioprotective effect in patients undergoing heart valve replacement.Methods:97 patients with heart valve replacement under cardiopulmonary bypass(CPB) received in our hospital from April 2019 to June 2021 were included.According to the envelope lottery method,the patients were divided into control group(fentanyl,48 cases) and observation group(dexmedetomidine combined with fentanyl,49cases).The hemodynamic indexes [mean arterial pressure(MAP),heart rate(HR)],myocardial injury indexes [troponin(cTnI),creatine kinase isoenzyme(CK-MB),heart fatty acid binding protein(HFABP)],brain injury indexes [neuron specific enolase(NSE),S-100β],cellular immune function,analgesia situation and incidence of adverse reactions of the two groups were compared.Results:The HR and MAP in the observation group were lower than those in the control group at 10 min(T2) after the beginning of CPB,but higher than those in the control group at the end of CPB(T3) and the end of operation(T4)(P<0.05).Visual analogue scale(VAS) scores in the two groups increased and then decreased before operation(T1),24 h after operation and 48 h after operation(P<0.05),and VAS scores in the observation group were lower than those in the control group at 24 h after operation and 48 h after operation(P<0.05).48 h after operation,CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group,while CD8^(+)was lower than that in the control group(P<0.05).The cTnI,CK-MB and HFABP in the observation group at 48 h after operation were lower than those in the control group(P<0.05).NSE and S100B in the observation group were lower than those in the control group at 48 h after operation(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:Dexmedetomidine combined with fentanyl anesthesia scheme for patients undergoing cardiac valve replacement can help relieve pain,stabilize hemodynamics,reduce immune suppression,and also play a protective effect on the heart and brain,reducing the incidence of adverse reactions,which is a reliable anesthesia program.