右美托咪定对体外循环下心脏手术患者术后认知功能及炎性因子、氧化应激介质的影响
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摘要
目的研究右美托咪定对体外循环下心脏手术患者术后认知功能及炎性因子、氧化应激介质的影响。方法选择2015年2月—2017年12月内蒙古医科大学附属医院行体外循环下心脏瓣膜置换手术患者68例,按随机数字表法分为2组,接受右美托咪定干预+常规麻醉的作为观察组(n=34),接受常规麻醉的作为对照组(n=34)。手术前(T1)、手术后24h(T2)、手术后48h(T3)按照简易精神状态检查(MMSE)量表评估认知功能,采集血清并检测炎性因子、氧化应激介质的水平。结果T2、T3时,2组患者MMSE评分值及血清SOD、GSH-Px水平均较T1时降低(P=0.000),血清cTnI、NSE、S100B、TNF-α、IL-1β、IL-6、ICAM-1、MDA、AOPP、NO含量均较T1时升高(P=0.000),且观察组患者T2、T3时MMSE评分及血清SOD、GSH-Px含量均高于对照组(T2时t/P=3. 881/0.000、6.619/0.000、8.197/0. 000,T3时t/P=2. 571/0.012、9. 752/0. 000、6. 887/0. 000),血清cTnI、NSE、S100B、TNF-α、IL-1β、IL-6、ICAM-1、MDA、AOPP,NO含量均低于对照组(T2时t/P=6. 738/0. 000、5. 433/0.000、6. 965/0. 000、6. 636/0. 000、6.296/0. 000、9.363/0.000、4. 822/0. 000、8. 111/0. 000、7. 753/0. 000、6. 407/0. 000,T3时t/P=7. 116/0. 000、5. 958/0.000、6.247/0.000、4. 662/0. 000、8. 382/0. 000、6. 388/0. 000、3. 901/0. 000、8. 463/0. 000、5. 133/0. 000、6. 156/0.000)。结论右美托咪定对体外循环下心脏手术患者术后认知功能具有改善作用,且能抑制炎性及氧化应激反应。
Objective To study the effects of dexmedetomidine on cognitive function, inflammatory factors and oxidative stress mediators in patients undergoing cardiac surgery under cardiopulmonary bypass. Methods Sixty eight patients undergoing cardiac valve replacement under cardiopulmonary bypass in Affiliated Hospital of Inner Mongolia Medical University from February 2015 to December 2017 were selected. They were divided into two groups according to random number table.The observation group( n =34) received dexmedetomidine intervention plus routine anesthesia and the control group( n =34) received routine anesthesia. Before operation(T1), 24 hours after operation(T2) and 48 hours after operation( T3),cognitive function was assessed by Mini-Mental State Examination(MMSE) scale. Serum was collected and levels of inflammatory factors and oxidative stress mediators were detected. Results At T2 and T3, the levels of MMSE scores, serum SOD and GSH-Px in the two groups were lower than those at T1( P = 0. 000), while the levels of serum cTnI, NSE, S100 B, TNF-α, IL-1β, IL-6, ICAM-1, MDA, AOPP and NO increased(P = 0.000), and the MMSE scores at T2 and T3 and the levels of serum SOD and GSH-Px in the observation group were higher than those in the control group( At T2, t/P = 3. 881/0. 000,t/P = 6.619/0.000. t/P = 8.197/0.000; At T3, t/P =2. 571/0. 012, t/P =-9. 752/0. 000, t/P = 6. 887/0. 000), serum cTnI, NSE, S100 B, TNF-α IL-1β, IL-6,ICAM-1, MDA, AOPP, NO levels were lower than those in control group(at T2:t/P = 6. 738/0. 000, t/P = 5. 433/0. 000, t/P = 6. 965/0. 000, t/P = 6. 636/0. 000, t/P = 6. 296/0. 000, t/P = 9. 363/0.000, t/P = 4. 822/0. 000.t/P = 8. 111/0. 000. t/P = 7. 753/0. 000,t/P = 6.407/0. 000; at T3: t/P = 7. 116/0.000,t/P =5.958/0. 000, t/P=6. 247/0. 000, t/P=4. 662/0. 000, t/P = 8. 382/0.000, t/P = 6. 388/0. 000, t/P=3.901/0.000, t/P = 8. 463/0.000,t/P = 5. 133/0. 000, t/P = 6. 156/0. 000). Conclusion Dexmedetomidine can improve cognitive function and inhibit inflammatory and oxidative stress in patients undergoing cardiac surgery under cardiopulmonary bypass.
Objective To study the effects of dexmedetomidine on cognitive function, inflammatory factors and oxidative stress mediators in patients undergoing cardiac surgery under cardiopulmonary bypass. Methods Sixty eight patients undergoing cardiac valve replacement under cardiopulmonary bypass in Affiliated Hospital of Inner Mongolia Medical University from February 2015 to December 2017 were selected. They were divided into two groups according to random number table.The observation group( n =34) received dexmedetomidine intervention plus routine anesthesia and the control group( n =34) received routine anesthesia. Before operation(T1), 24 hours after operation(T2) and 48 hours after operation( T3),cognitive function was assessed by Mini-Mental State Examination(MMSE) scale. Serum was collected and levels of inflammatory factors and oxidative stress mediators were detected. Results At T2 and T3, the levels of MMSE scores, serum SOD and GSH-Px in the two groups were lower than those at T1( P = 0. 000), while the levels of serum cTnI, NSE, S100 B, TNF-α, IL-1β, IL-6, ICAM-1, MDA, AOPP and NO increased(P = 0.000), and the MMSE scores at T2 and T3 and the levels of serum SOD and GSH-Px in the observation group were higher than those in the control group( At T2, t/P = 3. 881/0. 000,t/P = 6.619/0.000. t/P = 8.197/0.000; At T3, t/P =2. 571/0. 012, t/P =-9. 752/0. 000, t/P = 6. 887/0. 000), serum cTnI, NSE, S100 B, TNF-α IL-1β, IL-6,ICAM-1, MDA, AOPP, NO levels were lower than those in control group(at T2:t/P = 6. 738/0. 000, t/P = 5. 433/0. 000, t/P = 6. 965/0. 000, t/P = 6. 636/0. 000, t/P = 6. 296/0. 000, t/P = 9. 363/0.000, t/P = 4. 822/0. 000.t/P = 8. 111/0. 000. t/P = 7. 753/0. 000,t/P = 6.407/0. 000; at T3: t/P = 7. 116/0.000,t/P =5.958/0. 000, t/P=6. 247/0. 000, t/P=4. 662/0. 000, t/P = 8. 382/0.000, t/P = 6. 388/0. 000, t/P=3.901/0.000, t/P = 8. 463/0.000,t/P = 5. 133/0. 000, t/P = 6. 156/0. 000). Conclusion Dexmedetomidine can improve cognitive function and inhibit inflammatory and oxidative stress in patients undergoing cardiac surgery under cardiopulmonary bypass.
引文
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[3]Sifringer M, von Haefen C, Krain M, et al. Neuroprotective effect of dexmedetomidine on hyperoxia-induced toxicity in the neonatal rat brain[J]. Oxid Med Cell Longev, 2015, 2015:530371. DOI:10.1155/2015/530371.
[4]蒋玲玲,胡宪文,鲍丽君,等.右美托咪定预处理对瓣膜置换术患者缺血后心肌的影响[J].安徽医科大学学报,2017,52(6):859-863. DOI:10.19405/j. cnki. issn1000-1492.2017.06.018.
[5] Papadakis E, Kanakis M, Kataki A, et al. The spectrum of myocardial homeostasis mechanisms in the settings of cardiac surgery procedures(Review)[J]. Mol Med Rep, 2018, 17(2):2089-2099.DOI:10. 3892/mmr. 2017. 8174.
[6] Trakas E,Domnina Y, Panigrahy A, et al. Serum neuronal biomarkers in neonates with congenital heart disease undergoing cardiac Surgery[J]. Pediatr Neurol, 2017, 72(1):56-61. DOI:10.1016/j. pediatrneurol. 2017.04.011.
[7] Plicner D,Stolinski J, W sowicz M, et al. Preoperative values of inflammatory markers predict clinical outcomes in patients after CABG, regardless of the use of cardiopulmonary bypass[J]. Indian Heart J, 2016, 68(Suppl 3):S10-S15. DOI:10. 1016/j. ihj.2016. 10.002.
[8] Gorjipour F, Dehaki MG, Totonchi Z, et al. Inflammatory cytokine response and cardiac troponin I changes in cardiopulmonary bypass using two cardioplegia solutions; del Nido and modified St. Thomas':a randomized controlled trial[J]. Perfusion, 2017, 32(5):394-402. DOI:10.1177/0267659117691119.
[9] Poyrazolu HH, Duman Z, Demir S, et al. Investigating the impacts of preoperative steroid treatment on tumor necrosis factor-alpha and duration of extubation time underwent ventricular septal defect surgery[J]. Balkan Med J, 2016, 33(2):158-163. DOI:10.5152/balkanmedj.2016.16379.
[10] Cheng C, Xu JM, Yu T. Neutralizing IL-6 reduces heart injury by decreasing nerve growth factor precursor in the heart and hypothalamus during rat cardiopulmonary bypass[J]. Life Sci, 2017, 178(1):61-69. DOI:10.1016/j.lfs.2017.04.007.
[11] Kowalik MM, Lango R, Siondalski P, et al. Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgerythe INFLACOR study[J]. Acta Biochim Pol, 2018. 65(2):241-250. DOI:10.18388/abp.2017.2361.
[12] Sanchez-de-Toledo J, Chrysostomou C, Munoz R, et al. Cerebral regional oxygen saturation and serum neuromarkers for the prediction of adverse neurologic outcome in pediatric cardiac surgery[J]. Neurocrit Care, 2014, 21(1):133-1339 DOI:10. 1007/s12028-013-9934-y.
[13] Sznycer-Taub N, Mackie S, Peng YW, Donohue J, et al. Myocardial oxidative stress in infants undergoing cardiac surgery[J]. Pediatr Cardiol, 2016, 37(4):746-750. DOI:10. 1007/s00246-016-1345-3.
[14] Li F, Zong J, Zhang H, et al. Orientin reduces myocardial infarction size via eNOS/NO signaling and thus mitigates adverse cardiac Remodeling[J]. Front Pharmacol, 2017, 21(8):926. DOI:10.3389/fphar. 2017.00926.
[15] Baikoussis NG, Papakonstantinou NA, Verra C, et al. Mechanisms of oxidative stress and myocardial protection during open-heart surgery[J]. Ann Card Anaesth, 2015, 18(4):555-564. DOI:10.4103/0971-9784. 166465.
[2] Dong J, Guo X, Yang S, et al. The effects of dexmedetomidine preconditioning on aged rat heart of ischaemia reperfusion injury[J].Res Vet Sci, 2017, 114:489492. DOI:10. 1016/j. rvsc. 2017.09.028.
[3]Sifringer M, von Haefen C, Krain M, et al. Neuroprotective effect of dexmedetomidine on hyperoxia-induced toxicity in the neonatal rat brain[J]. Oxid Med Cell Longev, 2015, 2015:530371. DOI:10.1155/2015/530371.
[4]蒋玲玲,胡宪文,鲍丽君,等.右美托咪定预处理对瓣膜置换术患者缺血后心肌的影响[J].安徽医科大学学报,2017,52(6):859-863. DOI:10.19405/j. cnki. issn1000-1492.2017.06.018.
[5] Papadakis E, Kanakis M, Kataki A, et al. The spectrum of myocardial homeostasis mechanisms in the settings of cardiac surgery procedures(Review)[J]. Mol Med Rep, 2018, 17(2):2089-2099.DOI:10. 3892/mmr. 2017. 8174.
[6] Trakas E,Domnina Y, Panigrahy A, et al. Serum neuronal biomarkers in neonates with congenital heart disease undergoing cardiac Surgery[J]. Pediatr Neurol, 2017, 72(1):56-61. DOI:10.1016/j. pediatrneurol. 2017.04.011.
[7] Plicner D,Stolinski J, W sowicz M, et al. Preoperative values of inflammatory markers predict clinical outcomes in patients after CABG, regardless of the use of cardiopulmonary bypass[J]. Indian Heart J, 2016, 68(Suppl 3):S10-S15. DOI:10. 1016/j. ihj.2016. 10.002.
[8] Gorjipour F, Dehaki MG, Totonchi Z, et al. Inflammatory cytokine response and cardiac troponin I changes in cardiopulmonary bypass using two cardioplegia solutions; del Nido and modified St. Thomas':a randomized controlled trial[J]. Perfusion, 2017, 32(5):394-402. DOI:10.1177/0267659117691119.
[9] Poyrazolu HH, Duman Z, Demir S, et al. Investigating the impacts of preoperative steroid treatment on tumor necrosis factor-alpha and duration of extubation time underwent ventricular septal defect surgery[J]. Balkan Med J, 2016, 33(2):158-163. DOI:10.5152/balkanmedj.2016.16379.
[10] Cheng C, Xu JM, Yu T. Neutralizing IL-6 reduces heart injury by decreasing nerve growth factor precursor in the heart and hypothalamus during rat cardiopulmonary bypass[J]. Life Sci, 2017, 178(1):61-69. DOI:10.1016/j.lfs.2017.04.007.
[11] Kowalik MM, Lango R, Siondalski P, et al. Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgerythe INFLACOR study[J]. Acta Biochim Pol, 2018. 65(2):241-250. DOI:10.18388/abp.2017.2361.
[12] Sanchez-de-Toledo J, Chrysostomou C, Munoz R, et al. Cerebral regional oxygen saturation and serum neuromarkers for the prediction of adverse neurologic outcome in pediatric cardiac surgery[J]. Neurocrit Care, 2014, 21(1):133-1339 DOI:10. 1007/s12028-013-9934-y.
[13] Sznycer-Taub N, Mackie S, Peng YW, Donohue J, et al. Myocardial oxidative stress in infants undergoing cardiac surgery[J]. Pediatr Cardiol, 2016, 37(4):746-750. DOI:10. 1007/s00246-016-1345-3.
[14] Li F, Zong J, Zhang H, et al. Orientin reduces myocardial infarction size via eNOS/NO signaling and thus mitigates adverse cardiac Remodeling[J]. Front Pharmacol, 2017, 21(8):926. DOI:10.3389/fphar. 2017.00926.
[15] Baikoussis NG, Papakonstantinou NA, Verra C, et al. Mechanisms of oxidative stress and myocardial protection during open-heart surgery[J]. Ann Card Anaesth, 2015, 18(4):555-564. DOI:10.4103/0971-9784. 166465.
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