右美托咪定对体外循环冠状动脉旁路移植术老年患者的脑保护效应
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摘要
目的探讨右美托咪定术中持续静脉输注对体外循环冠状动脉旁路移植术(CABG)老年患者血清S-100β蛋白和神经元特异性烯醇化酶(NSE)浓度及术后认知功能的影响,以评价其脑保护效应。方法择期行CABG术老年患者40例,患者年龄65~75岁,体重指数22.4~27.5kg/m~2,性别不限,ASAⅡ或Ⅲ级,采用随机数字表法分为两组(n=20):对照组(N组)和右美托咪定组(D组)。D组诱导后右美托咪定以0.2μg/kg剂量输注负荷量后再以0.4μg/(kg·h)速率持续输注至术毕,N组输注等容量生理盐水。分别于手术切皮前即刻(T_0)、术毕即刻(T_1)、术后24h(T_2)、72h(T_3)时采颈内静脉血4ml,采用化学发光免疫分析技术测定血清S-100β蛋白和NSE浓度。采用MMSE于术前1天和术后第3天评价患者认知功能障碍发生率。结果与T_0时比较,N组和D组T_1~3时血清S-100β蛋白和NSE浓度均升高(P<0.01)。与N组比较,D组T_1~3时S-100β蛋白及NSE血清浓度明显降低(P<0.01)。与术前第1天值相比,N组术后第3天MMSE评分值降低(P<0.01);与N组相比,D组术后第3天评分值升高(P<0.05),术后第3天认知功能障碍发生率N组高于D组,差异有统计学意义(P<0.05)。结论常规麻醉诱导后静脉输注右美托咪定0.2μg/kg负荷量,随后以0.4μg/(kg·h)输注至术毕可降低体外循环下CABG老年患者术后认知功能障碍发生率,具有脑保护效应。
Objective To evaluate the cerebral protective effect of dexmedetomidine in the elder patients undergoing coronary artery bypass grafting with cardiopulmonary bypass( CPB). Methods Forty elder patients of both sexes,aged 65-75 years old,with body mass index of 22. 4-27. 5 kg/m~2,of ASA physical status Ⅱ or Ⅲ,scheduled for elective coronary artery bypass grafting with CPB,were randomly divided in 2 group( n = 20 each) using a random number table: normal saline group( group N) and dexmedetomidine group( group D). Dexmedetomidine was infused intravenously at a loading dose of 0. 2μg/kg over 10 min after induction of anesthesia,followed by0. 4μg/( kg·h) infusion until the end of surgery. The equal volume of normal saline was given instead in group N. The postoperative cognitive dysfunction( POCD) of patients were evaluated by using Mini-Mental State Examination at a day before operation and the 3 rd day after operation. Blood samples were collected from the internal juguler vein to determine the concentrations of S100β protein and neuron-speccific enzyme( NSE) in serum by chemiluminescence immunoassay at immediate operation before skin incision( baseline,T_0),immediately after operation( T_1),24 h( T_2) and 72 h( T_3) after operation. Results Compared with the baseline at T_0,the serum concentrations of S100β and NSE were significantly increased at T_(1-3)( P < 0. 01). Compared with group N,the serum concentrations of S100βand NSE were significantly decreased at T_(1-3) and the incidence of POCD at the 3 rdday after operation was significantly decreased in group D( P < 0. 01). Conclusion Dexmedetomidine infused intravenously at a loading dose of 0. 2 ug/kg over 10 min after induction of anesthesia,followed by 0. 4μg/( kg·h) infusion until the end of surgery can provide cerebral protection and decrease the incidence of POCD in the elder patients undergoing coronary artery bypass grafting with CPB.
Objective To evaluate the cerebral protective effect of dexmedetomidine in the elder patients undergoing coronary artery bypass grafting with cardiopulmonary bypass( CPB). Methods Forty elder patients of both sexes,aged 65-75 years old,with body mass index of 22. 4-27. 5 kg/m~2,of ASA physical status Ⅱ or Ⅲ,scheduled for elective coronary artery bypass grafting with CPB,were randomly divided in 2 group( n = 20 each) using a random number table: normal saline group( group N) and dexmedetomidine group( group D). Dexmedetomidine was infused intravenously at a loading dose of 0. 2μg/kg over 10 min after induction of anesthesia,followed by0. 4μg/( kg·h) infusion until the end of surgery. The equal volume of normal saline was given instead in group N. The postoperative cognitive dysfunction( POCD) of patients were evaluated by using Mini-Mental State Examination at a day before operation and the 3 rd day after operation. Blood samples were collected from the internal juguler vein to determine the concentrations of S100β protein and neuron-speccific enzyme( NSE) in serum by chemiluminescence immunoassay at immediate operation before skin incision( baseline,T_0),immediately after operation( T_1),24 h( T_2) and 72 h( T_3) after operation. Results Compared with the baseline at T_0,the serum concentrations of S100β and NSE were significantly increased at T_(1-3)( P < 0. 01). Compared with group N,the serum concentrations of S100βand NSE were significantly decreased at T_(1-3) and the incidence of POCD at the 3 rdday after operation was significantly decreased in group D( P < 0. 01). Conclusion Dexmedetomidine infused intravenously at a loading dose of 0. 2 ug/kg over 10 min after induction of anesthesia,followed by 0. 4μg/( kg·h) infusion until the end of surgery can provide cerebral protection and decrease the incidence of POCD in the elder patients undergoing coronary artery bypass grafting with CPB.
引文
1 Mahmoud M,Mason KP.Dexmedetomidine:review,update,and future considerations of paediatric perioperative and periprocedural applications and limitations[J].Br J Anaest,2015,115(2):171-182
2 Lang Y,Wang TL.Dexmedetomidine given application and progress of anesthesia in elderly[J].Chinese J New Drugs,2013,23(4):168-169
3 Bong CL,Lira E,Allen JC,et al.A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging[J].Anaesthesia,2015,70(4):393-399
4 Rasmussen LS.Defining postoperative cognitive dysfunction[J].Eur J Anaesthesiol,1998,15(6):761-764
5 Ko KH,Jun IJ,Lee S,et al.Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia[J].Korean J Anesthesiol,2015,68(6):575-580
6 Bharati S,Pal A,Biswas C,et al.Incidence of cardiac arrest increases with the indiscriminate use of dexmedetomidine:a case series and review of published ease reports[J].Acta Anaesthesiol Taiwan,2011,49(4):165-167
7 Ondruschka B,Pohlers D,Sommer G,et al.S100B and NSE as useful postmortem biochemial markers of traumatic brain injury in autopsy cases[J].J Neurotrauma,2013,30(22):1862-1871
8 Gazzolo D,Abella R,Marinoni E,et al.Circulating biochemical markers of brain damage in infants complicated by ischemia reperfusion injury[J].Cardiovasc Hematol Agents Med Chem,2009,7(2):108-126
9 Cotena S,Piazza O,Storti M.The S100βprotein and traumatic brain injury[J].J Neurosur,2006,104(Suppl 6):435-436
10 Rasmussen LS,Christiansen M,Rasmussen H,et al.Do blood concentrations of neurone specific enolase and S-100 beta protein reflect cognitive dysfunction after abdominal surgery?ISPOCD Group[J].Br J Anaesth,2000,84(2):242-244
11 Maldonado JR,Wysong A,van der Starre PJ,et al.Dexmedetomidine andthe reduction of postoperative delirium after cardiac surgery[J].Psychosomatics,2009,50(3):206-217
2 Lang Y,Wang TL.Dexmedetomidine given application and progress of anesthesia in elderly[J].Chinese J New Drugs,2013,23(4):168-169
3 Bong CL,Lira E,Allen JC,et al.A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging[J].Anaesthesia,2015,70(4):393-399
4 Rasmussen LS.Defining postoperative cognitive dysfunction[J].Eur J Anaesthesiol,1998,15(6):761-764
5 Ko KH,Jun IJ,Lee S,et al.Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia[J].Korean J Anesthesiol,2015,68(6):575-580
6 Bharati S,Pal A,Biswas C,et al.Incidence of cardiac arrest increases with the indiscriminate use of dexmedetomidine:a case series and review of published ease reports[J].Acta Anaesthesiol Taiwan,2011,49(4):165-167
7 Ondruschka B,Pohlers D,Sommer G,et al.S100B and NSE as useful postmortem biochemial markers of traumatic brain injury in autopsy cases[J].J Neurotrauma,2013,30(22):1862-1871
8 Gazzolo D,Abella R,Marinoni E,et al.Circulating biochemical markers of brain damage in infants complicated by ischemia reperfusion injury[J].Cardiovasc Hematol Agents Med Chem,2009,7(2):108-126
9 Cotena S,Piazza O,Storti M.The S100βprotein and traumatic brain injury[J].J Neurosur,2006,104(Suppl 6):435-436
10 Rasmussen LS,Christiansen M,Rasmussen H,et al.Do blood concentrations of neurone specific enolase and S-100 beta protein reflect cognitive dysfunction after abdominal surgery?ISPOCD Group[J].Br J Anaesth,2000,84(2):242-244
11 Maldonado JR,Wysong A,van der Starre PJ,et al.Dexmedetomidine andthe reduction of postoperative delirium after cardiac surgery[J].Psychosomatics,2009,50(3):206-217