右美托咪定对体外循环下瓣膜置换术患者炎症反应影响.pdfVIP

摘要在T2时是达最高，后逐渐降低至T4时最低。D组中只有T2时较Tl时明显增高(P0．05)。与C组比较，D组在T3、T4、T5时明显降低。而在T1和T2时两组的MDA水平无显著差异。另外， 组拔管时间与ICU停留时间均较C 缩短，差异有统计学意义(P0．05)。结论：术中静脉泵注0．5pg／kg‘hDEX可以降低体外循环瓣膜替换术患者术中及术后炎症反应的程度，且可以使患者拔管时间提前，对患者似乎有益。关键词：右美托咪定；心肺转流术；炎症反应；瓣膜替换术 Abstract ABSTRACT Objective：This study observes Dexmedetomidine’S(DEX)influence on inflammatory reaction in patients with heart valve replacement surgery under cardiopulmonary bypass(CPB)，to explore effectiveness and clinical significance of DEX for such surgeries． Methods：Selecting 30 patients undergoing elective open—cardiac valve replacement surgery研th CPB，inclusion criteria：age 20 to 65 years old，male or female，ASA classification is grade II or grade III，no heart block，left ventricular ejection fraction above 50％，no other serious medical complications．They were randomly devided into two groups：control group(Group C，n=15)and Dexmedetomidine group(Group D，n=1 5)．We administered Midazolam(0．1 mg／ kg)，Vecuronium(0．1 2 mg／kg)，Sufentanil(1 to 2 g／kg)and Propofol(0．5 to 1．0 mg ／kg)intravenously in induction of anesthesia，while conventional arteriovenous monitoring is got．During opermion，intravenous infusion of Propofol，Sufentanil， and Vecuroniurn Bromide and intermittent inhalmion of small doses of Sevoflurane were applied to maintenance of anesthesia．Before incision，DEX in continuous infusion were applied in Group D(O．599／kg·h)until the end of surgery，while the same dose of saline in Group C．We，collected blood in central veins at 5 time points：after induction of anesthesia(T 1)，1 0 minutes after the shutdown of CPB (T2)，6 h(T3)，12h(T4)，24 hours(T5)5 time points，respectively，then detected their concentrations of TNF—a，IL一1 0，SOD and MDA．Besides，all patients’ sufentanil，extubation time and ICU staying time were observed and recorded． Results：TNF一0【：The concentrations of TNF-0【had no significant difference between two groups at time T 1(P0．05)，But in Group D，TNF—Gc concentrations were higher than that in Group C at time T2，T3，T4，T5(P0．05)．In eve