| 甲强龙联合右美托咪定对体外循环下认知功能的影响 |
| 投稿时间：2016-03-24 修订日期：2016-04-21 点此下载全文 |
| 引用本文：崔小英,于建设,温再和.甲强龙联合右美托咪定对体外循环下认知功能的影响[J].医学研究杂志,2017,46(5):80-83,90 |
| DOI：
10.11969/j.issn.1673-548X.2017.05.021 |
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| 基金项目:内蒙古自治区自然科学基金资助项目[2015MS（LH）0803] |
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| 中文摘要:目的 评价甲强龙联合右美托咪定对体外循环（CPB）心脏瓣膜置换术患者脑认知功能的保护作用。方法 选择内蒙古医科大学附属医院CPB下行心脏瓣膜置换术患者60例，完全随机化分为4组（n=15），分别为对照组（A组）、甲强龙组（M组）、右美托咪定组（D组）和甲强龙联合右美托咪定组（B组），在麻醉诱导后气管插管，机械通气。M组在体外循环预冲液加入甲强龙20mg/kg，D组麻醉在诱导后静脉泵注右美托咪定1μg/kg负荷量，之后以0.05μg/（kg·h）速率静脉泵注至术毕，B组既麻醉诱导后静脉注射右美托咪定1μg/kg负荷量，然后以0.05μg/（kg·h）速率静脉输注至术毕又在体外循环预冲液加入甲强龙20mg/kg，A组给于等容量生理盐水。在麻醉后手术前（T1）、CPB即刻（T2）、CPB30min（T3）、CPB结束10min（T4）、术毕（T5）、CPB结束后6h（T6）时采集颈内静脉球部血样，使用酶联免疫吸附实验（ELISA）法测定血清IL-6、IL-10、S100β蛋白和神经元特异性烯醇化酶（NSE）的浓度。记录术前1天术后2天、3天、7天采用简化智能评分量表（MMSE）评估患者认知功能。结果 M组、D组和B组在T1~6各个时间点IL-6、S100β蛋白和NSE均比对照组明显降低，IL-10均比对照组升高，差异有统计学差异（P<0.05）。B组在T1~6各个时间点IL-6、S100β蛋白和NSE均比其他组更低，IL-10均比其他组更高，差异有统计学意义（P<0.05）。M组、D组和B组术后发生认知功能障碍的发生率均高于对照组，B组发生认知功能障碍的发生率最低，差异有统计学意义（P<0.05）。结论 甲强龙和右美托嘧啶均可以有效降低体外循环中IL-6、S100β蛋白和NSE的浓度，降低脑损伤，减少术后认知功能障碍的发生率，联合应用甲强龙和右美托嘧啶对体外循环后脑损伤的保护效果更佳。 |
| 中文关键词:甲强龙 右美托咪定 认知功能 |
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| Effects of Methylprednisolone Combined with Dexmedetomidine on Cognitive Function under Cardiopulmonary Bypass |
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| Abstract:Objective To evaluate the protective effects of methylprednisolone combined with dexmedetomidine of cardiac valve replacement in patients with brain cognitive function under cardiopulmonary bypass (CPB). Methods Sixty patients for heart valve replacement in Affiliated Hospital.Inner Mongolia Medical University were randomly divided into four groups (n=15 each) : group A control, methylprednisolone group (group M), dexmedetomidine group (Group D) and methylprednisolone combined with dexmedetomidine group (group B).After the induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated. Methylprednisolone 20mg/kg was administered to the CPB circuit prime in group M. A loading dose of dexmedetomidine 1μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μg/(kg·h) until the end of operation in group D.A loading dose of dexmedetomidine 1μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μg/(kg·h) until the end of operation and methylprednisolone 20mg/kg was also administered to the CPB circuit prime in group B.At the same time the equal volume of normal saline was given in group A. After induction(T1),CPB instantly(T2),CPB 30min(T3),10min after CPB(T4),at the end of operation(T5),6h after CPB(T6),the jugular bulb venous blood samples were taken for testing the serum concentrations of interleukin-6(IL-6), interleukin-10(IL-10), S100βprotein and neuron-specific enolase(NSE) using the method of ELISA.Simplified mini-mental state examination (MMSE) is used to assess the cognitive function of patients in pre-operation and 2days,3days as well as 7days after operation. Results At T1-6, IL-6,S100 protein and NSE in group M,group D and group B were significantly lower than those in control group, IL-10 was higher than that in control group, and there was significant difference (P<0.05).In B group at all time points IL-6、S100 protein and NSE were lower than those in other groups, IL-10 was higher than other groups, and there was significant differences (P<0.05). The incidence of postoperative cognitive dysfunction in group M, group D and group B was higher than that in control group, and the incidence of cognitive dysfunction in B group was lowest, and there were significant differences (P<0.05). Conclusion Methylprednisolone and dexmedetomidine can effectively reduce the concentration of IL-6, S100 protein and NSE in cardiopulmonary bypass, reduce brain injury and the incidence of postoperative cognitive dysfunction.The protective effect on cerebral injury is better when using dexmedetomidine combined with methylprednisolone under cardiopulmonary bypass (CPB). |
| keywords:Methylprednisolone Dexmedetomidine Cognitive function |
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