2022 年第 11 期 第 17 卷

右美托咪定联合丙泊酚干预对体外循环下心脏瓣膜置换术患者血流动力学和心肌损伤及细胞免疫功能的影响

Effects of dexmedetomidine combined with propofol on hemodynamics, myocardial injury and cellular immune function in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作者：王晓艳1呼延静1党璐1吴丹1郭靖2

英文作者：Wang Xiaoyan1 Hu Yanjing1 Dang Lu1 Wu Dan1 Guo Jing2

单位：1延安大学附属医院麻醉科，延安716000；2延安大学附属医院心外科，延安716000

英文单位：1Department of Anesthesiology Yan′an University Affiliated Hospital Yan′an 716000 China; 2Department of Cardiac Surgery Yan′an University Affiliated Hospital Yan′an 716000 China

关键词：体外循环；心脏瓣膜置换术；右美托咪定；丙泊酚；血流动力学；心肌损伤；免疫功能

英文关键词：Cardiopulmonarybypass;Cardiacvalvereplacement;Dexmedetomidine;Propofol;Hemodynamics;Myocardialinjury;Immunefunction

• 摘要：

• 目的 探讨右美托咪定联合丙泊酚干预对体外循环下心脏瓣膜置换术患者血流动力学、心肌损伤、细胞免疫功能的影响。方法 选取2019年12月至2021年12月延安大学附属医院收治的120例体外循环下心脏瓣膜置换术患者，按随机数字表法分为观察组和对照组，各60例。患者进入手术室后均行常规心电监护和麻醉诱导，气管插管后，对照组恒速静脉泵注5 mg/（kg·h）丙泊酚乳状注射液干预，观察组在对照组基础上加用0.4 μg/（kg·h）盐酸右美托咪定注射液干预，达深度麻醉后，实施常规麻醉维持并进行手术治疗。观察2组患者围手术期指标，比较麻醉诱导前10 min（T0）、体外循环开始后30 min（T1）、体外循环结束（T2）、术毕（T3）时的平均动脉压（MAP）、心率及肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）水平以及术前、术中、术后24 h的CD+4、CD+8、CD+4/CD+8比值及血尿素氮、胱抑素C水平。比较2组患者围手术期不良反应发生情况。结果 观察组心脏复跳时间、术后苏醒时间、术后拔管时间、重症监护病房滞留时间、术后住院时间均短于对照组［（96±9）s比（104±10）s、（6.0±0.5）h比（7.1±0.7）h、（13.1±2.2）h比（16.3±2.3）h、（26.2±2.6）h比（29.6±2.6）h、（15.1±1.5）d比（18.3±1.4）d］（均P＜0.001）。T1～T3时点，观察组MAP、心率均高于对照组，CK-MB、cTnI水平均低于对照组（均P＜0.05）。术中、术后24 h，观察组CD+8水平低于对照组，CD+4水平、CD+4/CD+8比值高于对照组（均P＜0.05），但2组血尿素氮、胱抑素C水平比较差异均无统计学意义（均P＞0.05）。2组不良反应发生率比较差异无统计学意义（P=0.464）。结论 右美托咪定联合丙泊酚有利于维持体外循环下心脏瓣膜置换术患者的血流动力学稳定，减轻心肌损伤和免疫功能抑制，改善围手术期指标，且安全性较高。

• Objective To investigate the effects of dexmedetomidine combined with propofol on hemodynamics, myocardial injury and cellular immune function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Totally 120 patients undergoing cardiac valve replacement under CPB were collected from December 2019 to December 2021 in Yan′an University Affiliated Hospital. According to the random number table method, patients were divided into observation group  and control group, with 60 cases in each group. After entering the operating room, all patients received routine electrocardiogram monitoring and anesthesia induction. After endotracheal intubation, the control group was intravenous pumped with a constant rate of 5 mg/(kg·h) propofol injectable emulsion, and the observation group was injected with 0.4 μg/(kg·h) dexmedetomidine hydrochloride injection on the basis of the control group. After reaching the depth of anesthesia, routine anesthesia maintenance and surgical treatment were performed. The perioperative period indexes of the two groups were observed, and the mean arterial pressure (MAP), heart rate (HR), creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) levels were compared at 10 min before anesthesia induction (T0), 30 min after the beginning of CPB (T1), the end of CPB (T2), and the end of operation (T3). The levels of CD+4, CD+8, CD+4/CD+8 ratio, blood urea nitrogen (BUN) and cystatin C (CysC) were compared before, during and 24 h after operation. The occurrence of perioperative period adverse reactions in the two groups was compared. Results The cardiac rebound time, postoperative recovery time, postoperative extubation time, intensive care unit retention time and postoperative length of stay in the observation group were shorter than those in the control group［（96±9）s vs （104±10）s, （6.0±0.5）h vs （7.1±0.7）h, （13.1±2.2）h vs （16.3±2.3）h, （26.2±2.6）h vs （29.6±2.6）h, （15.1±1.5）d vs （18.3±1.4）d］（all P＜0.001）. From T1 to T3, the MAP and HR of the observation group were higher than those of the control group, and levels of CK-MB and cTnI were lower than those of the control group (all P＜0.05). During and 24 h after operation, the levels of CD+8 of the observation group were lower than those of the control group, and the levels of CD+4, CD+4/CD+8 ratio were higher than those of the control group (all P＜0.05), however, there were no significant differences in the levels of BUN and CysC between the two groups (all P＞0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.464). Conclusion Dexmedetomidine combined with propofol is beneficial and safe to maintain hemodynamic stability, reduce myocardial injury and immunosuppression, and improve perioperative indicators in patients undergoing cardiac valve replacement under CPB.