| 摘要: |
| ［摘要］ 目的 观察右美托咪定复合阿片类药物对体外循环心脏手术患者围术期的心肺保护作用，以期为麻醉药物的合理应用提供临床指导。方法 招募2016年5月至2018年3月于广西壮族自治区人民医院在全麻低温心肺转流下行单瓣置换术的患者120例，采用随机数字表法将其分为舒芬太尼组（S组）、芬太尼组（F组）、舒芬太尼+右美托咪定组（SD组）和芬太尼+右美托咪定组（FD组），每组30例。比较四组患者术中情况，于入手术室前1 d（T0）、术后1 d（T1）、术后3 d（T2）、术后7 d（T3）检测炎性因子，以及肌酸激酶同工酶MB（CK-MB）与肌钙蛋白I（cTnI）水平，并计算氧合指数（OI）、肺泡-动脉氧分压差［P（A-aDO2）］等肺功能指标。结果 SD组舒芬太尼用量显著低于S组（P<0.05）；FD组芬太尼用量显著低于F组（P<0.05）；SD组丙泊酚用量、咪达唑仑用量均低于其他三组，差异有统计学意义（P<0.05）。在T1～T3时间点，SD组、FD组白细胞(WBC)、中性粒细胞百分比（N%）、C反应蛋白（CRP）、超敏C反应蛋白（hs-CRP）水平均分别显著低于S组和F组（P<0.05）。在T1时间点，SD组CRP、hs-CRP水平显著低于FD组（P<0.05）；在T2、T3时间点，SD组WBC、N%、CRP、hs-CRP水平均显著低于FD组（P<0.05）。在T1～T3时间点，SD组、FD组CK-MB、cTnI水平均分别显著低于S组和F组（P<0.05）。在T1时间点，SD组cTnI水平显著低于FD组（P<0.05）；在T2时间点，SD组CK-MB、cTnI水平显著低于FD组（P<0.05）；在T3时间点，SD组CK-MB水平显著低于FD组（P<0.05）。结论 右美托咪定复合舒芬太尼或芬太尼方案均可减轻机体的炎性应激反应及心肺器官功能损伤，且右美托咪定复合舒芬太尼方案效果更优。 |
| 关键词: 右美托咪定 舒芬太尼 体外循环 心肺保护 |
| DOI：10.3969/j.issn.1674-3806.2024.10.13 |
| 分类号:R 614.2 |
| 基金项目:广西自然科学基金面上项目（编号：2023GXNSFAA026324）；广西医疗卫生适宜技术开发与推广应用项目（编号：S2019074，S2022008）；南宁市青秀区科技计划项目（编号：2019033）；广西中医药适宜技术开发与推广项目（编号：GZSY22-58）；广西卫健委科研课题（编号：Z20210258）；广西中医药管理局自筹经费科研课题（编号：GXZYZ20210558） |
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| Study on the cardiopulmonary protective effect of dexmedetomidine combined with opioids on patients undergoing cardiopulmonary bypass surgery during the perioperative period |
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GONG Zheng1,2, SONG Siming1, LU Liuyu1, JIANG Yuhua1, LI Jun1, MA Li1
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1.Department of Anesthesiology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 2.Guangxi Medical University, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To observe the cardiopulmonary protective effect of dexmedetomidine combined with opioids on patients undergoing cardiopulmonary bypass surgery during the perioperative period in order to provide clinical guidance for rational application of anesthetic drugs. Methods One hundred and twenty patients who underwent single valve replacement under general anesthesia and hypothermia cardiopulmonary bypass in the People′s Hospital of Guangxi Zhuang Autonomous Region from May 2016 to March 2018 were recruited and divided into sufentanil group(S group), fentanyl group(F group), sufentanil+dexmedetomidine group(SD group) and fentanyl+dexmedetomidine group(FD group) by random number table method, with 30 cases in each group. The patients′ intraoperative conditions were compared among the four group. The inflammatory factors, creatine kinase isoenzyme-MB(CK-MB) and cardiac troponin I(cTnI) levels were detected 1 day before entering the operation room(T0), 1 day after operation(T1), 3 days after operation(T2), and 7 days after operation(T3). Oxygenation index(OI), alveolar arterial pressure difference［P(A-aDO2)］ and the other indexes of lung function were calculated. Results The dosage of sufentanil in the SD group was significantly lower than that in the S group(P<0.05) and the dosage of fentanyl in the FD group was significantly lower than that in the F group(P<0.05). The dosages of propofol and midazolam in the SD group were lower than those in the other three groups, and the differences were statistically significant(P<0.05). At T1 to T3 time points, the levels of white blood cell(WBC), percentage of neutrophils(N%), C-reactive protein(CRP) and hypersensitive C-reactive protein(hs-CRP) in the SD group and the FD group were significantly lower than those in the S group and the F group, respectively(P<0.05). At T1 time point, the levels of CRP and hs-CRP in the SD group were significantly lower than those in the FD group(P<0.05). The levels of WBC, N%, CRP and hs-CRP in the SD group were significantly lower than those in the FD group at T2 and T3 time points(P<0.05). At T1 to T3 time points, the levels of CK-MB and cTnI in the SD group and the FD group were significantly lower than those in the S group and the F group, respectively(P<0.05). At T1 time point, the level of cTnI in the SD group was significantly lower than that in the FD group(P<0.05). At T2 time point, the levels of CK-MB and cTnI in the SD group were significantly lower than those in the FD group(P<0.05). At T3 time point, the level of CK-MB in the SD group was significantly lower than that in the FD group(P<0.05). Conclusion Dexmedetomidine combined with sufentanil or fentanyl regimen can reduce inflammatory stress response and cardiopulmonary organ function injury, and dexmedetomidine combined with sufentanil regimen is more effective. |
| Key words: Dexmedetomidine Sufentanil Cardiopulmonary bypass Cardiopulmonary protection |
