右美托咪定预处理对体外循环瓣膜置换患者脑氧代谢功能的影响
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摘要
目的观察右美托咪定预处理对体外循环瓣膜置换患者脑氧代谢功能的影响。方法选择新乡医学院第一附属医院2016年1～12月择期行心瓣膜置换术患者60例为研究对象,将患者随机分为右美托咪定组和生理盐水组,每组30例。生理盐水组患者麻醉诱导前10 min静脉泵注生理盐水;右美托咪定组患者麻醉诱导前10 min静脉泵注0.5μg·kg~(-1)右美托咪定,之后静脉泵注右美托咪定0.2μg·kg~(-1)至术毕。于麻醉诱导后即刻(T1)、阻断升主动脉前(T2)、心脏复跳后(T3)、停止心肺转流(T4)及术毕(T5)时经桡动脉及颈静脉球部采血行血气分析,检测2组患者各时间点颈内动脉乳酸水平(Laca)、颈静脉球乳酸水平(Lacjv)、动脉血氧分压(PaO_2)、颈静脉血氧饱和度(SjvO_2)、动-静脉血氧含量差(Da-jvO_2)和脑氧摄取率(CERO_2)。结果 2组患者T2时Laca、Lacjv和SjvO_2显著高于T1时(P<0.05),Da-jvO_2、CERO_2显著低于T1时(P<0.05); 2组患者T2时的PaO_2与T1时比较差异无统计学意义(P>0.05)。2组患者T3～T5时的Laca、Lacjv、PaO_2、CERO_2显著高于T1时(P<0.05),SjvO_2显著低于T1时(P<0.05); Da-jvO_2与T1比较差异无统计学意义(P>0.05)。2组患者T3～T5时的PaO_2、Da-jvO_2、CERO_2显著高于T2时(P<0.05),SjvO_2显著低于T2时(P<0.05); Laca、Lacjv在T3时显著高于T2时(P<0.05),在T4、T5时显著低于T2时(P<0.05)。生理盐水组患者T4、T5时Laca、Lacjv、Da-jvO_2、CERO_2显著低于T3时(P<0.05),PaO_2和SjvO_2显著高于T3时(P<0.05);右美托咪定组患者T4、T5时Laca、Lacjv、PaO_2、Da-jvO_2、CERO_2显著低于T3时(P<0.05),SjvO_2显著高于T3时(P<0.05)。2组患者T5与T4时各指标比较差异均无统计学意义(P>0.05)。2组患者T1时各指标比较差异均无统计学意义(P>0.05)。T2时,右美托咪定组患者SjvO_2显著高于生理盐水组(P<0.05),Dajv O_2和CERO_2显著低于生理盐水组(P<0.05); 2组患者T2时Laca、Lacjv和PaO_2比较差异均无统计学意义(P>0.05)。T3、T4时,右美托咪定组患者的Laca和Lacjv显著低于生理盐水组(P<0.05),PaO_2和SjvO_2显著高于生理盐水组(P<0.05); T3时,右美托咪定组患者的Da-jvO_2和CERO_2显著低于生理盐水组(P<0.05),T4时,2组患者的Da-jvO_2和CERO_2比较差异无统计学意义(P>0.05)。T5时,右美托咪定组患者的Laca和Lacjv显著低于生理盐水组(P<0.05);其余各指标2组比较差异均无统计学意义(P>0.05)。结论右美托咪定预处理可提高CERO_2,增加脑组织氧含量,促进脑能量代谢及脑组织氧供需平衡。
Objective To observe the effect of dexmedetomidine pretreatment on cerebral oxygen metabolism in patients undergoing cardiopulmonary bypass valve replacement. Methods Sixty patients who underwent selective heart valve replacement in the First Affiliated Hospital of Xinxiang Medical College from January to December 2016 were selected as the study subjects. The patients were randomly divided into dexmedetomidine group and saline group,with 30 patients in each group. The patients in the saline group were given normal saline by intravenous infusion at 10 min before induction of anesthesia; the patients in the dexmedetomidine group were given dexmedetomidine(0.5 μg·kg~(-1)) by intravenous infusion at10 min before induction of anesthesia,then the patients were given 0.2 μg·kg~(-1) dexmedetomidine until the end of operation.The blood samples were taken from radial artery and jugular bulb at the time after the induction of anesthesia(T1),before blocking ascending aorta(T2),after cardiac resuscitation(T3),after stopping cardiopulmonary bypass(T4) and after operation(T5) to perform the blood gas analysis. The lactic acid content in artery(Laca),lactic acid content in jugular bulb(Lacjv),partial pressure of arterial(PaO_2),jugular venous oxygen saturation(SjvO_2),arterial venous oxygen content difference(Da-jvO_2) and cerebral extraction of oxygen(CERO_2) were detected at each time points. Results The levels of Laca,Lacjv and SjvO_2 at T2 were significantly higher than those at T1 in the two groups(P<0.05); while the Da-jvO_2 and CERO_2 were lower than those at T1(P<0.05); there was no significant difference in the PaO_2 between T1 and T2 in the two groups(P>0.05). The levels of Laca,Lacjv,PaO_2 and CERO_2 at T3-T5 were significantly higher than those at T1(P<0.05),while the level of SjvO_2 was significantly lower than that at T1(P<0.05) in the two groups; there was no significant difference in the level of Da-jvO_2 between the T3-T5 and T1 in the two groups(P>0.05). The levels of PaO_2,Da-jvO_2 and CERO_2 at T3-T5 were significantly higher than those at T2 in the two groups(P<0.05); while the level of SjvO_2 was significantly lower than that at T2 in the two groups(P<0.05); the levels of Laca and Lacjv at T3 were significantly higher than those at T2,and at T4,T5 were significantly lower than those at T2(P<0.05). Comapred with T3,the levels of Laca,Lacjv,Da-jvO_2 and CERO_2 at T4,T5 were decreased,and the levels of PaO_2,SjvO_2 at T4,T5 were increased in the saline group(P<0.05); the levels of Laca,Lacjv,PaO_2,Da-jvO_2 and CERO_2 at T4,T5 were decreased,and the level of SjvO_2 at T4,T5 were increased in the dexmedetomidine group(P<0.05). There was no significant difference in the levels of all indexes between T4,T5 in the two groups(P>0.05). There was no significant difference in the levels of all indexes at T1 between the saline group and dexmedetomidine group(P>0.05). At the time point of T2,the level of SjvO_2 of patients in the dexmedetomidine group was significantly higher than that in the saline group(P<0.05),the levels of Da-jvO_2 and CERO_2 of patients in the dexmedetomidine group were significantly lower than those in the saline group(P<0.05); there was no significant difference in the levels of Laca,Lacjv,PaO_2 between the two group at T2(P>0.05). At T3 and T4,the levels of Lacjv and Lacjv in dexmedetomidine group were significantly lower than those in the saline group(P<0.05),the levels of PaO_2 and SjvO_2 were significantly higher than those in the saline group(P<0.05); the levels of Da-jvO_2 and CERO_2 of patients in the dexmedetomidine group were significantly lower than those in the saline group at T3(P<0.05); there was no significant difference in the levels of Da-jvO_2 and CERO_2 of patients between the two groups at T4(P>0.05). At T5,the levels of Laca and Lacjv in the dexmedetomidine group were significantly lower than those in the saline group(P<0.05),and there was no significant difference in the other indexes between the two groups(P>0.05). Conclusion Dexmedetomidine pretreatment can improve the CERO_2,increase oxygen content in brain tissue,promote brain energy metabolism and the balance of oxygen supply and demand in brain tissue.
Objective To observe the effect of dexmedetomidine pretreatment on cerebral oxygen metabolism in patients undergoing cardiopulmonary bypass valve replacement. Methods Sixty patients who underwent selective heart valve replacement in the First Affiliated Hospital of Xinxiang Medical College from January to December 2016 were selected as the study subjects. The patients were randomly divided into dexmedetomidine group and saline group,with 30 patients in each group. The patients in the saline group were given normal saline by intravenous infusion at 10 min before induction of anesthesia; the patients in the dexmedetomidine group were given dexmedetomidine(0.5 μg·kg~(-1)) by intravenous infusion at10 min before induction of anesthesia,then the patients were given 0.2 μg·kg~(-1) dexmedetomidine until the end of operation.The blood samples were taken from radial artery and jugular bulb at the time after the induction of anesthesia(T1),before blocking ascending aorta(T2),after cardiac resuscitation(T3),after stopping cardiopulmonary bypass(T4) and after operation(T5) to perform the blood gas analysis. The lactic acid content in artery(Laca),lactic acid content in jugular bulb(Lacjv),partial pressure of arterial(PaO_2),jugular venous oxygen saturation(SjvO_2),arterial venous oxygen content difference(Da-jvO_2) and cerebral extraction of oxygen(CERO_2) were detected at each time points. Results The levels of Laca,Lacjv and SjvO_2 at T2 were significantly higher than those at T1 in the two groups(P<0.05); while the Da-jvO_2 and CERO_2 were lower than those at T1(P<0.05); there was no significant difference in the PaO_2 between T1 and T2 in the two groups(P>0.05). The levels of Laca,Lacjv,PaO_2 and CERO_2 at T3-T5 were significantly higher than those at T1(P<0.05),while the level of SjvO_2 was significantly lower than that at T1(P<0.05) in the two groups; there was no significant difference in the level of Da-jvO_2 between the T3-T5 and T1 in the two groups(P>0.05). The levels of PaO_2,Da-jvO_2 and CERO_2 at T3-T5 were significantly higher than those at T2 in the two groups(P<0.05); while the level of SjvO_2 was significantly lower than that at T2 in the two groups(P<0.05); the levels of Laca and Lacjv at T3 were significantly higher than those at T2,and at T4,T5 were significantly lower than those at T2(P<0.05). Comapred with T3,the levels of Laca,Lacjv,Da-jvO_2 and CERO_2 at T4,T5 were decreased,and the levels of PaO_2,SjvO_2 at T4,T5 were increased in the saline group(P<0.05); the levels of Laca,Lacjv,PaO_2,Da-jvO_2 and CERO_2 at T4,T5 were decreased,and the level of SjvO_2 at T4,T5 were increased in the dexmedetomidine group(P<0.05). There was no significant difference in the levels of all indexes between T4,T5 in the two groups(P>0.05). There was no significant difference in the levels of all indexes at T1 between the saline group and dexmedetomidine group(P>0.05). At the time point of T2,the level of SjvO_2 of patients in the dexmedetomidine group was significantly higher than that in the saline group(P<0.05),the levels of Da-jvO_2 and CERO_2 of patients in the dexmedetomidine group were significantly lower than those in the saline group(P<0.05); there was no significant difference in the levels of Laca,Lacjv,PaO_2 between the two group at T2(P>0.05). At T3 and T4,the levels of Lacjv and Lacjv in dexmedetomidine group were significantly lower than those in the saline group(P<0.05),the levels of PaO_2 and SjvO_2 were significantly higher than those in the saline group(P<0.05); the levels of Da-jvO_2 and CERO_2 of patients in the dexmedetomidine group were significantly lower than those in the saline group at T3(P<0.05); there was no significant difference in the levels of Da-jvO_2 and CERO_2 of patients between the two groups at T4(P>0.05). At T5,the levels of Laca and Lacjv in the dexmedetomidine group were significantly lower than those in the saline group(P<0.05),and there was no significant difference in the other indexes between the two groups(P>0.05). Conclusion Dexmedetomidine pretreatment can improve the CERO_2,increase oxygen content in brain tissue,promote brain energy metabolism and the balance of oxygen supply and demand in brain tissue.
引文
[1]秦鹏宇,马闻苛,张红伟,等.右美托咪定对开胸手术患者应激反应及血流动力学的影响[J].新乡医学院学报,2017,34(10):896-900.
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[3]周红梅,张毅,曹峰,等.慢性瘢痕溃疡合并心脏瓣膜置换术一例[J].中华损伤与修复杂志:电子版,2013,8(4):396-397.DOI:10.3877/cma.j.issn.1673-9450.2013.04.015.
[4]张玉辉,高亚坤,肖连波,等.右美托咪定对老年心脏瓣膜置换术患者心肌保护和脑保护的影响[J].中国老年学杂志,2015,35(16):4606-4608.
[5]张慧,张涛元,王森,等.右美托咪定对非体外循环下冠状动脉旁路移植术中心肌氧供需平衡的影响[J].中国体外循环杂志,2017,15(2):86-91.
[6]杨华,陈海燕,沈袁东,等.右美托咪定对老年高血压全麻病人围手术期心肌的保护作用[J].安徽医药,2017,21(4):721-724.
[7]武勇,张小宝,钱燕宁,等.右美托咪定对高血压心肌肥厚患者围术期心肌保护作用[J].中国应用生理学杂志,2016,32(5):459-462.
[8]吴志林,褚淑娟,姚尚龙,等.不同剂量右美托咪定预处理对大鼠心肌缺血再灌注损伤以及炎症反应的影响[J].华中科技大学学报(医学版),2015,44(4):445-447.
[2]龚湘玲,姚滨,黄志勇.右美托咪定用于心血管手术的研究进展[J].岭南心血管病杂志,2016,22(2):237-240.
[3]周红梅,张毅,曹峰,等.慢性瘢痕溃疡合并心脏瓣膜置换术一例[J].中华损伤与修复杂志:电子版,2013,8(4):396-397.DOI:10.3877/cma.j.issn.1673-9450.2013.04.015.
[4]张玉辉,高亚坤,肖连波,等.右美托咪定对老年心脏瓣膜置换术患者心肌保护和脑保护的影响[J].中国老年学杂志,2015,35(16):4606-4608.
[5]张慧,张涛元,王森,等.右美托咪定对非体外循环下冠状动脉旁路移植术中心肌氧供需平衡的影响[J].中国体外循环杂志,2017,15(2):86-91.
[6]杨华,陈海燕,沈袁东,等.右美托咪定对老年高血压全麻病人围手术期心肌的保护作用[J].安徽医药,2017,21(4):721-724.
[7]武勇,张小宝,钱燕宁,等.右美托咪定对高血压心肌肥厚患者围术期心肌保护作用[J].中国应用生理学杂志,2016,32(5):459-462.
[8]吴志林,褚淑娟,姚尚龙,等.不同剂量右美托咪定预处理对大鼠心肌缺血再灌注损伤以及炎症反应的影响[J].华中科技大学学报(医学版),2015,44(4):445-447.