右美托咪定在心脏瓣膜置换手术麻醉过程对于大脑的保护作用的观察与分析

发布时间：2019-03-04 17:18

【摘要】：目的评价右美托咪定在心脏瓣膜置换手术麻醉中的脑保护作用。方法将我院择期行体外循环下心脏瓣膜置换术的患者150例,随机分为右美托咪定组和对照组(n=75)。右美托咪定组在常规麻醉诱导前10 min内静脉注射右美托咪定1.0μg/kg,之后以0.5μg·kg~(-1)·h~(-1)静脉输注至术毕;对照组给予等量的生理盐水。于体外循环开始前即刻(T1)、升主动脉开放即刻(T2)、体外循环结束后10 min(T3)、术后6 h(T4)时记录颈静脉血氧饱和度(SjvO_2)、动脉-颈内静脉血氧含量差(Da-jvO_2)及脑氧摄取率(CERO_2),并分别于T1、T2、T3、T4时间点及术后24 h(T5)采用ELISA的方法测定2组血浆S~(-1)00β蛋白及神经元特异性烯醇化酶(NSE)水平。结果与T1时间点相比较,右美托咪定组和对照组T2时间点SjvO_2明显升高,CERO_2明显降低;2组T2、T3、T4时间点S~(-1)00β蛋白、NSE水平升高(P0.05);右美托咪定组T2、T3时间点SjvO_2高于对照组,Da-jvO_2、CERO_2低于对照组(P0.05),T2、T3、T4时间点S~(-1)00β蛋白及NSE水平均低于对照组(P0.05)。结论对于进行心脏瓣膜置换术的中年患者,在术中应用右美托咪定可改善脑氧代谢,减少术中可能出现的脑缺血缺氧状态,一定程度上具有脑保护作用。
[Abstract]:Objective to evaluate the cerebral protective effect of dexmetometomidine in cardiac valve replacement anesthesia. Methods 150 patients undergoing cardiac valve replacement under cardiopulmonary bypass were randomly divided into two groups: right metametramine group and control group (n = 75). The right metametridamidine group was injected intravenously with 1.0 渭 g / kg, of right metametamil 10 min before the induction of conventional anesthesia until the end of the operation with 0.5 渭 g kg~ (- 1) h ~ (- 1), and the control group was given the same amount of normal saline. The jugular oxygen saturation (SjvO_2) was recorded immediately before the start of cardiopulmonary bypass (T1), immediately after ascending aorta opening (T2), 10 min (T3) after CPB, and 6 hours after CPB (T4). The difference of blood oxygen content (Da-jvO_2) and cerebral oxygen uptake rate (CERO_2) between artery and internal jugular vein were at T1, T2, T3, respectively. The levels of plasma S1 00 尾 protein and neuron specific enolase (NSE) were measured by ELISA at T4 time point and 24 h after operation (T5). Results compared with T1 time point, SjvO_2 in right metometomidine group and control group increased significantly at T2 time point, and CERO_2 decreased significantly, S1 尾 protein and NSE level increased at T2, T3, T4 time point (P0.05). The levels of S1 尾 protein and NSE at T 2, T 3 and T 4 in the right metometridine group were lower than those in the control group (P0.05). The levels of S1 尾 protein and NSE were lower in the right metometridine group than those in the control group (P0.05). Conclusion for middle-aged patients undergoing cardiac valve replacement, the use of right metomidine can improve cerebral oxygen metabolism and decrease the possible cerebral ischemia and hypoxia, which may have brain protective effect to a certain extent in the middle-aged patients undergoing cardiac valve replacement. [WT5 "HZ] [WT5" HZ] conclusion [WTBZ]
【作者单位】：西安交通大学医学部;陕西省人民医院心脏外科;西安交通大学医学部公共卫生学院流行病与卫生统计学系;
【分类号】：R614

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