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不同麻醉剂对体外循环下心瓣膜置换术患者围手术期器官保护及术后认知功能的影响。

Effects of Different Anesthetics on Perioperative Organ Protection and Postoperative Cognitive Function in Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass.

机构信息

Department of Anesthesiology, People's Hospital of Wuhan University, Wuhuna, China.

Department of Pain, People's Hospital of Wuhan University, Wuhuna, China.

出版信息

Comput Intell Neurosci. 2022 May 29;2022:8994946. doi: 10.1155/2022/8994946. eCollection 2022.

Abstract

In this paper, we have carried out an experimental study to investigate the effects of different anesthetics on perioperative organ protection and postoperative cognitive function in patients undergoing cardiac valve replacement with cardiopulmonary bypass. To realize this idea, a total of 90 patients with single valve replacement under general anesthesia and hypothermic cardiopulmonary bypass from January 2020 to October 2021 were enrolled. These patients were assigned into three groups, with 30 cases in each group by the digital table method. Group A was anesthetized with sufentanil combined with dexmedetomidine. Group B was anesthetized with sufentanil combined with etomidate. Group C was anesthetized with sufentanil combined with propofol. Perioperative organ protection and postoperative cognitive function of the three groups were compared. At time point, there was no significant difference in blood WBC, blood , and CRP among groups A, B, and C ( > 0.05); At and time points, the indexes of blood WBC, blood , and CRP in groups A, B, and C were higher compared to the time point. At and time points, the indexes of blood WBC, blood and CRP in group A were significantly lower compared to group B and group C. Before treatment, there was no significant difference in ALT and AST among groups A, B, and C ( > 0.05). After treatment, the indexes of ALT and AST in group A were significantly lower compared to group B and group C at and time points ( < 0.05). Before treatment, there was no significant difference in urea and creatinine among groups A, B, and C ( > 0.05). After treatment, the urea and creatinine indexes of group A were significantly lower compared to group B and group C at and time points ( < 0.05). Before treatment, there was no significant difference in CK-MB and CTnl among groups A, B, and C ( > 0.05); After treatment, the indexes of CK-MB and CTnl in group A were significantly lower compared to group B and group C at and time points (  < 0.05). Before treatment, there was no significant difference in MOCA scores among groups A, B, and C ( > 0.05). After treatment, the MOCA scores of group A were significantly higher compared to group B and group C at and time points (  < 0.05). Sufentanil combined with dexmedetomidine for heart valve replacement under cardiopulmonary bypass can reduce the dosage of anesthetics during the operation and have a certain perioperative protective effect on important organs such as the heart, lung, liver, and kidney, which may be related to reducing intraoperative hemodynamic fluctuations and inhibiting inflammatory stress response.

摘要

在本文中,我们进行了一项实验研究,旨在探讨不同麻醉剂对体外循环下心瓣膜置换术患者围手术期器官保护和术后认知功能的影响。为了实现这一目标,我们共纳入了 90 例 2020 年 1 月至 2021 年 10 月期间接受全身麻醉和低温体外循环下单瓣膜置换术的患者。这些患者采用数字表法分为三组,每组 30 例。A 组采用舒芬太尼联合右美托咪定麻醉,B 组采用舒芬太尼联合依托咪酯麻醉,C 组采用舒芬太尼联合丙泊酚麻醉。比较三组患者围手术期器官保护和术后认知功能。在 时间点,A、B、C 三组患者的白细胞计数(WBC)、血清 、C 反应蛋白(CRP)差异无统计学意义( > 0.05);在 和 时间点,A、B、C 三组患者的 WBC、血清 、CRP 指标均高于 时间点。在 和 时间点,A 组患者的 WBC、血清 和 CRP 指标明显低于 B 组和 C 组。治疗前,A、B、C 三组患者的丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)差异无统计学意义( > 0.05)。治疗后,A 组患者在 和 时间点的 ALT 和 AST 指标明显低于 B 组和 C 组( < 0.05)。治疗前,A、B、C 三组患者的尿素氮(BUN)和肌酐(Cr)差异无统计学意义( > 0.05)。治疗后,A 组患者在 和 时间点的 BUN 和 Cr 指标明显低于 B 组和 C 组( < 0.05)。治疗前,A、B、C 三组患者的肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白 I(CTnl)差异无统计学意义( > 0.05);治疗后,A 组患者在 和 时间点的 CK-MB 和 CTnl 指标明显低于 B 组和 C 组(  < 0.05)。治疗前,A、B、C 三组患者的蒙特利尔认知评估量表(MOCA)评分差异无统计学意义( > 0.05)。治疗后,A 组患者在 和 时间点的 MOCA 评分明显高于 B 组和 C 组(  < 0.05)。体外循环下心瓣膜置换术中舒芬太尼联合右美托咪定可减少术中麻醉剂用量,对心、肺、肝、肾等重要器官具有一定的围手术期保护作用,这可能与减少术中血流动力学波动和抑制炎症应激反应有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41d5/9168101/83c8afc6e904/CIN2022-8994946.001.jpg

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