【摘要】 目的观察右美托咪定对心内直视手术患者炎性反应和胰岛素抵抗的影响。方法择期在心肺转流(CPB)下行心脏瓣膜置换术的患者50例,随机均分为观察组和对照组。观察组麻醉诱导后静注右美托咪定负荷量1.0μg/kg(给药时间15min),随后泵注0.4μg·kg-1·h-1至CPB结束;对照组静注等容量生理盐水。于麻醉诱导后切皮前(T1)、CPB开始后30 min(T2)、停CPB(T3)、CPB结束后2h(T4)采集静脉血检测血清TNF-α、IL-6、胰岛素及血糖水平,计算胰岛素敏感指数(ISI)=1/(血糖×胰岛素)。结果与T1时比较,T2~T4时两组TNF-α、IL-6、胰岛素、血糖明显升高,ISI明显降低(P<0.05)。与对照组比较,观察组T2~T4时TNF-α和IL-6,T2、T3时胰岛素和血糖均明显降低(P<0.05),而T2、T3时ISI明显升高(P<0.05)。两组患者均未出现低血压和心动过缓等不良反应。结论右美托咪定可明显减少CPB下心内直视手术患者炎性反应,降低术中血糖,改善胰岛素抵抗。更多还原

【Abstract】 Objective To observe the effects of dexmedetomidine on inflammatory responses and insulin resistance during cardiac operations with cardiopulmonary bypass(CPB).Methods Fifty patients scheduled for elective cardiac valve replacement with CPB were equally and randomly divided into two groups using a random number table:observation group and control group(n=25).A loading dose of dexmedetomidine 1.0μg/kg was injected intravenously over 15 min after induction,followed by continuous infusion at 0.4μg·kg-1·h-1until the end of CPB in doservation group.While the equal volume of normal saline was given in control group.After induction(T1),at 30 min after the beginning of CPB(T2),at the end of CPB(T3),and at 2hafter the end of CPB(T4),the jugular venous blood samples were taken for determination of serum concentrations of TNF-a,IL-6,insulin and blood glucose.The insulin sensitivity index(ISI) = 1/(glucose × insulin)was obtained.Results Compared with control group,the serum TNF-a and IL-6concentrations at T2-T4 were significantly decreased in observation group(P<0.05),the serum insulin and blood glucose concentrations at T2,T3 were significantly decreased in observation group(P<0.05),the ISI at T2,T3 were significantly increased in observation group(P<0.05).Conclusion Dexmedetomidine can reduce inflammatory responses,thus reducing insulin resistance and blood glucose during cardiac operations with CPB.更多还原