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)。T
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 December2016 were selected as the study subjects.The patients were randomly divided into dexmedetomidine group and saline group,with30 patients in each group.The patients in the saline group were given normal saline by intravenous infusion at10 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 (PaO2),jugular venous oxygen saturation (SjvO2),arterial venous oxygen content difference (Da-jvO2) and cerebral extraction of oxygen (CERO2) were detected at each time points. Results The levels of Laca,Lacjv and SjvO2 at T2 were significantly higher than those at T1 in the two groups ( P <0.05);while the Da-jvO2 and CERO2 were lower than those at T1( P <0.05);there was no significant difference in the PaO2 between T1and T2 in the two groups( P >0.05 ).The levels of Laca,Lacjv,PaO2 and CERO2 at T3-T5 were significantly higher than those at T1( P <0.05),while the level of SjvO2 was significantly lower than that at T1( P <0.05) in the two groups;there was no significant difference in the level of Da-jvO2 between the T3-T5 and T1 in the two groups( P >0.05).The levels of PaO2,Da-jvO2 and CERO2 at T3-T5 were signif
作者
李晓芳
张红伟
樊腾
马闻苛
杨明月
徐璐丹
胡淋淋
张文杰
岳修勤
LI Xiao-fang;ZHANG Hong-wei;FAN Teng;MA Wen-ke;YANG Ming-yue;XU Lu-dan;HU Lin-lin;ZHANG Wen-jie;YUE Xiu-qin(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2019年第5期431-434,共4页
Journal of Xinxiang Medical University
基金
河南省高等学校重点科研项目计划(编号:18B310020)
河南省卫生科技创新型人才工程中青年科技创新人才基金资助项目(编号:20114155)
关键词
右美托咪定
预处理
脑氧代谢功能
静脉血氧饱和度
脑氧摄取率
dexmedetomidine
pretreatment
cerebral oxygen metabolismfunction
jugular venous oxygen saturation
cerebral oxygen extractionrate
