Qiu Yongsheng, Li Chan, Li Xiaoqin, Jia Yingping
Department of Anesthesiology Children's Hospital Affiliated to Zhengzhou University Henan Children's Hospital Zhengzhou Children' s Hospital Henan Engineering Research Center of Childhood Neurodevelopment Zhengzhou China.
Department of Pharmaceutical Science University of Buffalo Buffalo New York USA.
Pediatr Investig. 2020 Mar 17;4(1):23-28. doi: 10.1002/ped4.12176. eCollection 2020 Mar.
Dexmedetomidine inhibits the inflammatory response associated with cardiopulmonary bypass (CPB) and protects neural function. However, the mechanism of dexmedetomidine's anti-inflammatory pathway is unclear.
To investigate the effect of dexmedetomidine on the cognitive level and expression of inflammatory factors in children with congenital heart disease undergoing intraoperative CPB.
Ninety children with congenital heart disease were recruited and randomly divided into 3 groups of 30 children in each. In Group 1, a 1.0 µg·kg·h intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia, followed by a 0.2 µg·kg·h infusion until the surgical incision. In Group 2, a 0.5 µg/kg intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia, followed by a 0.1 µg·kg·h infusion until the surgical incision. The control group was given physiological saline using the same method as in Groups 1 and 2. The serum levels of nuclear factor-kappa B (NF-κB), S-100β protein, neuron-specific enolase (NSE), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured before the surgery (T1), at the end of CPB (T2), 2 hours after CPB (T3), 6 hours after CPB (T4), and 24 hours after CPB (T5). The Wechsler Intelligence Scale for children (WISC) was measured before the operation and at 3, 6, and 12 months after the operation to evaluate the neurodevelopmental state of the children.
The levels of the NF-κB, S-100β protein, NSE, TNF-α, IL-6 were significantly higher at T2, T3, or T4 than before the surgery (T1) in the control group or the dexmedetomidine groups. However, the increases of NF-κB, TNF-α, IL-6, S-100β and NSE levels were significantly smaller in the dexmedetomidine groups than those in the control group ( 0.017). The WISC scores were similar among the three groups before or after the operation.
The increases in NF-κB, TNF-α, and IL-6 levels indicated aggravation of the inflammatory reaction and the increase S-100β protein and NSE levels indicated that the nervous system was damaged. Administration of dexmedetomidine to children with congenital heart disease undergoing intraoperative CPB can inhibit the inflammatory response and may ameliorate the neurodevelopmental damage caused by CPB.
右美托咪定可抑制与体外循环（CPB）相关的炎症反应并保护神经功能。然而，右美托咪定抗炎途径的机制尚不清楚。
探讨右美托咪定对先天性心脏病患儿术中CPB时认知水平及炎症因子表达的影响。
招募90例先天性心脏病患儿，随机分为3组，每组30例。第1组在麻醉诱导后10分钟静脉推注1.0μg·kg·h右美托咪定，随后以0.2μg·kg·h持续输注直至手术切口。第2组在麻醉诱导后10分钟静脉推注0.5μg/kg右美托咪定，随后以0.1μg·kg·h持续输注直至手术切口。对照组采用与第1组和第2组相同的方法给予生理盐水。于手术前（T1）、CPB结束时（T2）、CPB后2小时（T3）、CPB后6小时（T4）及CPB后24小时（T5）测定血清核因子-κB（NF-κB）、S-100β蛋白、神经元特异性烯醇化酶（NSE）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平。术前及术后3、6和12个月采用儿童韦氏智力量表（WISC）评估患儿神经发育状态。
对照组和右美托咪定组在T2、T3或T4时NF-κB、S-100β蛋白、NSE、TNF-α、IL-6水平均显著高于手术前（T1）。然而，右美托咪定组NF-κB、TNF-α、IL-6、S-100β和NSE水平的升高显著低于对照组（P<0.017）。三组手术前后的WISC评分相似。
NF-κB、TNF-α和IL-6水平升高表明炎症反应加重，S-100β蛋白和NSE水平升高表明神经系统受损。对先天性心脏病患儿术中CPB时给予右美托咪定可抑制炎症反应，并可能改善CPB所致的神经发育损伤。
