右美托咪定对心脏单瓣膜置换患者脑保护作用.docVIP

右美托咪定对心脏单瓣膜置换患者脑保护作用 　　【摘要】 目的 观察右美托咪定对体外循环单瓣膜置换手术（CPB-VR）患者围术期脑保护的作用。方法 60例择期单瓣膜置换手术患者随机分为右美托咪定组（D组）和对照组（C组）， 每组30例。D组于麻醉诱导前10 min泵注右美托咪定（1 μg/kg）， 术中以0.5 μg/（kg?h）的速度持续泵注至患者拔管。C组用等容量的等渗生理盐水替代。于右美托咪定用药前（T0）、体外循环结束后（T1）、体外循环结束后6 h （T2）、体外循环结束后24 h T3 4个时间点分别采集颈静脉血检测神经组织蛋白（S-100β）和神经元特异性烯醇化酶（NSE）。结果 两组患者在T1和T2时 S-100β和NSE的浓度均明显高于T0；与C组比较， D组患者S-100β和NSE的浓度在T1和T2时均降低， 差异均有统计学意义（P0.05）。结论 心肺转流术可引起S-100β和NSE含量升高， 右美托咪定能够降低体外循环下单瓣膜置换手术患者血清S-100β和NSE升高的水平， 具有一定的脑保护作用。 　　【关键词】 右美托咪定；心脏单瓣膜置换； 神经组织蛋白；神经元特异性烯醇化酶；脑保护 　　DOI：10.14163/j.cnki.11-5547/r.2015.26.007 　　Cerebral protection effect by dexmedetomidine for isolated cardiac valve replacement patients ZHANG Hao， LIU Zhi-wu， HU Yuan-wei， et al. Department of Anesthesiology， Shandong Yantai City Peoples Liberation Army 107 Hospital， Yantai 264002， China 　　【Abstract】 Objective To observe cerebral protection effect in perioperative period by dexmedetomidine for cardiopulmonary bypass-isolated cardiac valve replacement （CPB-VR） patients. Methods A total of 60 isolated cardiac valve replacement patients were randomly divided into dexmedetomidine group （group D） and control group （group C）， with 30 cases in each group. Group D received dexmedetomidine （1 μg/kg） in 10 min before anesthesia induction， and continuous pumping by 0.5 μg/（kg?h）. Group C received normal saline for replacement by the same dose. Nervous tissue protein （S-100β） and neuron-specific enolase （NSE） were detected in jugular blood samples at 4 time points， as before dexmedetomidine administration （T0）， at the end of cardiopulmonary bypass （T1）， in 6 h after cardiopulmonary bypass （T2）， and in 24 h after cardiopulmonary bypass （T3）. Results Both groups had higher concentrations of S-100β and NSE at T1 and T2 than those at T0. Compared with group C， group D had lower S-100β and NSE at T1 and T2， the differences all had statistical significance （P0.05）. Conclusion Cardiopulmonary bypass will lead to increased S-100β and NSE levels， while dexmedetomidine can re