| 摘要: |
| 目的：探讨右美托咪定对先天性心脏病患儿围手术期血流动力学、心肌及脑功能指标的影响。方法：选取海南省人民医院及四川大学华西第二医院2017年8月至2018年8月收治的房间隔缺损或室间隔缺损需行修补术患儿98例，随机分为观察组（49例）和对照组（49例）。对照组进行基础常规麻醉、气管插管和机械通气，观察组在对照组基础上静脉注射右美托咪定，剂量为0.5 μg/(kg·d)，直到手术完成。检测两组患儿体外循环（CPB）开始前（T1）、CPB结束10 min（T2）、术后6 h（T3）和术后12 h（T4）4个时间点血流动力学指标（心率、收缩压、舒张压），在这4个时间点分别采集血液，采用ELISA试剂盒检测S-100β和神经元特异性烯醇化酶（NSE）水平以及缺血修饰白蛋白（IMA）、心肌肌钙蛋白I（cTnI）水平。结果：与对照组比较，观察组T2、T3时间点心率降低（P<0.05），收缩压、舒张压升高（P<0.01）；观察组T2、T3、T4时间点IMA、cTnI、S-100β、NSE水平均降低（P<0.01）。与T1时间点比较，观察组T2和T3时间点心率均升高（P<0.05）；收缩压和舒张压各时间点比较差异无统计学意义（P>0.05）；T2、T3、T4时间点IMA、cTnI、S-100β、NSE水平显著升高（P<0.05）。结论：右美托咪定可维持先天性心脏病患儿动脉血压的稳定、降低心率、改善心肌损伤，降低NES和S-100β蛋白的水平。 |
| 关键词: 右美托咪定 先天性心脏病 血流动力学 心肌损伤 脑损伤 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2020.10.004 |
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| 基金项目:海南省自然科学基金项目,编号818MS125。 |
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| Effects of Dexmedetomidine on Myocardial and Brain Injury in Children with Congenital Heart Disease during Perioperative Period |
| Li Na1, Li Tiejun1, Xiong Lu1, Wu Yehua1, Chen Xiaojian1, Meng Yazhen1, Wu Duozhi1, Xiong Yaqin2, Fang Dengfeng3 |
| (1. Hainan General Hospital, Hainan Hospital of Hainan Medical College, Hainan Haikou 570100, China; 2. West China Second University Hospital, Sichuan University, Sichuan Chengdu 610041, China; 3. West China First Hospital of Sichuan University, Sichuan Chengdu 610041, China) |
| Abstract: |
| Objective: To probe into the effects of dexmedetomidine on hemodynamics, myocardial and brain function indexes in children with congenital heart disease during perioperative period. Methods: A total of 98 children with atrial septal defect or ventricular septal defect admitted into Hainan General Hospital and West China Second University Hospital, Sichuan University from Aug. 2016 to Aug. 2018 were extracted to be randomly divided into the observation group and the control group, with 49 cases in each group. The control group received conventional anesthesia, tracheal intubation and mechanical ventilation. The observation group was given intravenous injection of dexmedetomidine at a dose of 0.5 μg/(kg·h) on the basis of the control group until the surgery was completed. Hemodynamic indicators (heart rate, systolic blood pressure and diastolic blood pressure) were measured before cardiopulmonary bypass (CPB) surgery (T1), 10 minutes after CPB (T2), 6 hours after CPB (T3), and 12 hours after CPB (T4). Blood was collected at the four time points. Levels of S-100β and neuron-specific enolase (NSE), ischemia-modified albumin (IMA) and cardiac troponin I (cTnI) were detected by ELISA. Results: Compared with the control group, the heart rate of the observation group decreased at T2 and T3 (P<0.05), while systolic and diastolic blood pressure increased (P<0.01). The levels of IMA, cTnI, S-100β and NSE in the observation group decreased at T2, T3, and T4 (P<0.01). Compared with T1, the heart rate increased at T2 and T3 in the observation group (P<0.05). There was no significant difference between systolic blood pressure and diastolic blood pressure at each time point (P>0.05). The levels of IMA, cTnI, S-100β and NSE increased significantly at T2, T3 and T4 (P<0.05). Conclusion: Dexmedetomidine can maintain the stability of arterial blood pressure in children with congenital heart disease, reduce the heart rate, improve the myocardial damage, and decrease the levels of NSE and S-100β protein. |
| Key words: dexmedetomidine congenital heart disease hemodynamics myocardial injury brain injury |
