右美托咪定和丙泊酚对先天性心脏病患儿体外循环后脑保护作用的对比

【摘要】 目的比较右美托咪定和丙泊酚对先天性心脏病患儿体外循环(CPB)后血清中星形胶质细胞S100β蛋白(S100β)及神经元特异性烯醇化酶(NSE)的浓度的影响。方法选择择期体外循环下行先天性心脏病患儿45例,年龄1~2岁之间,采用随机数字表法,分成3组:丙泊酚组(B1)、右美托咪定组(B2)和对照组(C),麻醉诱导后B1组给予丙泊酚8 mg/(kg·h)静脉持续泵入至术毕;B2组给予右美托咪定0.4μg/(kg·h)(15 min内),随后以0.1μg/(kg·h)匀速泵入至术毕;C组采用与B1组相同给药方式静脉持续泵入等体积生理盐水。3组术中均持续泵入维库溴胺60.0~100.0μg/(kg·h)、舒芬太尼2.0μg/(kg·h),持续吸入七氟烷1%~3%,分别于手术开始前(T1)、CPB结束(T2)、CPB结束后6 h(T3)、12 h(T4)、24 h(T5)检测血液中S-100β蛋白和NSE的浓度。结果 T1时,3组患儿血清中的S100β蛋白及神经元特异性烯醇化酶(NSE)的浓度差异无统计学意义。T2、T3、T4点时,B1、B2组血清中S100β和NSE的浓度均低于C组,差异具有统计学意义(P<0.05);B2与B1组相比,B2组血清中S100β和NSE浓度上升幅度较低,差异具有统计学意义(P<0.05)。各组患儿围术期血压、心率等血流动力学指标差异无统计学意义。结论右美托咪定和丙泊酚均可降低CPB下先天性心脏病患儿血清中IL-1β及S100蛋白的浓度,具有一定的脑保护作用,且右美托咪定的脑保护作用较丙泊酚强。更多还原

【Abstract】 Objective Compare the effects on concentrations of S-100 protein and neuron specific enolase(NSE) in serum after cardiopulmonary bypass in children with congenital heart disease. Methods Undergoing cardiopulmonary bypass(CPB) downlink: children with congenital heart disease in 45 cases, age from 1 to 2 years old, divided into three groups: Propofol group(B1) and dexmedetomidine group(B2) and control group(C), anesthesia after induction of B1 were given propofol 8mg /(kg·h) intravenous continuous infusion to postoperative; B2 group given dexmedetomidine 0.4μg/(kg·h)(15 minutes), then to 0.1μg /(kg·h) uniform pump into the postoperative; C group by group B1 and the same continuous pump into an equal volume of normal saline intravenous drug delivery. Three groups were continued infusion of vecuronium bromide 60.0~100.0μg/(kg·h), sufentanil 2.0ug/(kg·h), the continuous inhalation of sevoflurane 1%-3%, respectively at the beginning of operation(T1), after CPB end(T2), at the end of CPB 6h(T3), 12 h(T4) and 24h(T5) taken from the radial artery blood 1m L send laboratory, detection of S-100 protein and NSE concentration. Results T1, the 3 groups of children with serum S100 beta protein and neuron specific(NSE) concentration was not statistically different. T2, T3, T4, compared with group C, B1, B2 group of serum S100 and NSE concentrations were decreased, with statistical significance(P< 0.05); B2 and B1 group compared to B2 group of serum S100β and NSE concentration increased with lower amplitude, with statistical significance(P<0.05). There was no significant difference in blood pressure and heart rate in the perioperative period of the patients in each group. Conclusion Dexmedetomidine and propofol can reduce the concentrations of IL-1 beta and S100β protein in serum of children with congenital heart disease in for CPB, it means that they have a certain role in protecting brain and dexmedetomidine has a better effect.更多还原