右美托咪定对术后患者认知功能及miR-155水平的影响

Effects of dexmedetomidine on cognitive function and miR-155 level in postoperative patients

目的评价右美托咪定对全弓置换术患者术后认知功能及miR-155水平的影响。方法选择2021-07—2022-09在郑州大学第二附属医院因急性主动脉夹层行全弓置换术患者38例。采用随机数字表法将患者随机分为对照组(C组)和实验组(Dex组)。D组静脉输注Dex 1μg/kg,输注时间15 min,输注完成后以0.5μg/(kg·h)的速率输注Dex至手术结束即刻,对照组给予等量和等速度的生理盐水采取同样的方式持续泵注至手术结束即刻。采用简易精神状态检查表(minimum Mental State Examination,MMSE)评价入室后(T0)、术后24 h(T5)、术后72 h(T6)的认知功能,并记录T0、诱导后(T1)、深低温停循环后(T2)、停CPB即刻(T3)、手术结束即刻(T4)、T5和T6的MAP、HR、SPO_(2)、P_(ET)CO_(2)等的情况。于T0、T1、T2、T3、T4、T5和T6抽血5m L检测血清miR-155水平。记录患者心动过缓情况并计算其发生率。记录患者的手术时间、体外循环时间、ICU停留时间和住院时间。结果血清miR-155相对表达水平比较,观察组T3、T4、T5时间点的血清miR-155水平均降低(P值分别为0.031、0.037、0.002),差异有统计学意义。与T0时间点相比,2组在T5、T6时间点的MMSE评分降低(P<0.05)。与C组相比,D组在T5、T6时间点的MMSE评分增高(P<0.001);D组的POCD发生率明显低于C组(5.26%vs 36.84%);D组ICU停留时间明显低于C组[(31.63±5.12)h vs(57.16±8.19)h],差异有统计学意义(P<0.01)。结论右美托咪定对全弓置换术患者术后认知功能障碍有一定的预防作用,能够减少患者的ICU停留时间,可能与其下调血清miR-155表达水平有关。

Objective To evaluate the effects of dexmedetomidine on postoperative cognitive function and miR-155 level in patients with total arch replacement.Methods A total of 38 patients who underwent total arch replacement due to acute aortic dissection in the Second Affiliated Hospital of Zhengzhou University from July 2021 to September 2022 were selected.Patients were randomly divided into control group(group C)and experi⁃mental group(group Dex)by random number table method.Group D was given intravenous infusion of Dex 1μg/kg for 15min.After the infusion,Dex was injected at the rate of 0.5μg(/kg·h)until immediately after the opera⁃tion.The control group was given the same amount and the same speed of normal saline and pumped in the same way until immediately after the operation.The Minimum Mental State Examination(MMSE)was used to evaluate the cognitive function after entry(T0),T5,and T6.MAP,HR,SPO_(2),P_(ET)CO_(2) were recorded at T0,after induction(T1),after cryopreservation(T2),immediately after CPB stop(T3),immediately after surgery(T4),T5 and T6.5ml of blood was extracted in T0,T1,T2,T3,T4,T5 and T6 to detect serum miR-155.Bradycardia was recorded in both groups and its incidence was calculated.Operation time,extracorporeal circulation time,ICU stay time and hospital stay time were recorded in both groups.Results Compared with the relative expression level of se⁃rum miR-155 between the two groups,the serum miR-155 level at T3,T4 and T5 time points in the observation group was decreased(The Ps were 0.031,0.037 and 0.002),and the difference was statistically significant.Com⁃pared with T0 time points,MMSE scores of the 2 groups at T5 and T6 time points were decreased(P<0.05).Com⁃pared with group C,MMSE scores in group D at T5 and T6 were higher(P<0.001).The incidence of POCD in group D was significantly lower than that in group C(5.26%vs 36.84%).ICU stay time in group D was signifi⁃cantly lower than that in group C(31.63±5.12vs57.16±8.19),and the difference was statistically significant(P<0.001).Conclusion Dexmedetomidine has a certain preventive effect on postoperative cognitive dysfunction in patients with total arch replacement,and can reduce the length of ICU stay,which may be related to down-regula⁃tion of serum miR-155 expression level.