右美托咪定联合丙泊酚对体外循环下心脏瓣膜置换术患者心肌损伤、肾功能和细胞免疫功能的影响

摘要 目的：观察右美托咪定联合丙泊酚对体外循环（CPB）下心脏瓣膜置换术患者心肌损伤、肾功能和细胞免疫功能的影响。方法：回顾性分析2020年1月~2020年12月期间新疆医科大学第一附属医院收治的120例CPB下心脏瓣膜置换术患者的临床资料，根据麻醉方案的不同将患者分为对照组和研究组，各为60例，对照组患者接受丙泊酚麻醉，研究组患者接受右美托咪定联合丙泊酚麻醉。观察两组患者围术期指标、血流动力学、心肌损伤、肾功能和细胞免疫功能变化情况，记录两组围术期不良反应发生情况。结果：研究组患者的心脏复跳时间、术后苏醒时间、术后拔管时间、ICU滞留时间、术后住院时间均短于对照组患者（P<0.05）。术前（T0）~术毕（T3）时间点，两组患者的平均动脉压（MAP）、心率（HR）先下降后升高，肌酸激酶同工酶（CK-MB）和肌钙蛋白I（cTnI）水平则持续升高（P<0.05），但CPB开始后30 min（T1）~ T3时间点，研究组患者的MAP、HR高于对照组患者，CK-MB、cTnI水平则低于对照组患者（P<0.05）。两组患者T0、术中、术后24 h 的尿素氮（BUN）、血清胱抑素C（CysC）水平呈升高趋势（P<0.05）。术中、术后24 h两组患者的CD4⁺、CD4⁺/CD8⁺均较T0下降，但研究组高于对照组（P<0.05）；术中、术后24 h两组患者的CD8⁺较T0升高，但研究组低于对照组（P<0.05）。两组不良反应发生率对比无统计学差异（P>0.05）。结论：右美托咪定联合丙泊酚应用于CPB下心脏瓣膜置换术患者，可减轻心肌损伤和细胞免疫功能抑制，维持血流动力学稳定，且不增加肾功能损伤和不良反应发生率。

Effects of Dexmedetomidine Combined with Propofol on Myocardial Injury, Renal Function and Cellular Immune Function in Patients Undergoing Heart Valve Replacement under Cardiopulmonary Bypass

ABSTRACT Objective: To observe the effects of dexmedetomidine combined with propofol on myocardial injury, renal function and cellular immune function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods: The clinical data of 120 patients with cardiac valve replacement under CPB who were treated in the First Affiliated Hospital of Xinjiang Medical University from January 2020 to December 2020 were analyzed retrospectively, they were randomly divided into control group and study group according to different anesthesia schemes, with 60 cases in each group. Patients in the control group received propofol anesthesia, and patients in the study group received dexmedetomidine combined with propofol anesthesia. The perioperative indexes, hemodynamics, myocardial injury, renal function and cellular immune function in the two groups were observed, and the perioperative adverse reactions in the two groups were recorded. Results: The cardiac repulse time, postoperative recovery time, postoperative extubation time, ICU stay time and postoperative hospitalization time in the study group were shorter than those in the control group (P<0.05). The mean arterial pressure (MAP) and heart rate (HR) decreased first and then increased in two groups from pre-operation (T0) to post-operation (T3) time point, while the levels of creatine kinase isoenzyme (CK-MB) and troponin I (cTnI) continued to increase (P<0.05), but 30min after CPB (T1) to T3 time point, MAP and HR in the study group were higher than those in the control group, while the levels of CK-MB and cTnI were lower than those in the control group (P<0.05). The levels of brea nitrogen (BUN), serum cystatin C(CysC) showed an upward trend at T0, intraoperative and postoperative 24 hours in two groups (P<0.05). CD4⁺ and CD4⁺/CD8⁺ at intraoperative and postoperative 24 hours in two groups decreased compared with T0, but the study group was higher than the control group(P<0.05), CD8⁺ at intraoperative and postoperative 24 hours in two groups increased compared with T0, but the study group was lower than the control group (P<0.05). There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Dexmedetomidine combined with propofol in patients undergoing cardiac valve replacement under CPB can reduce myocardial injury and inhibition of cellular immune function, maintain hemodynamic stability, and do not increase the incidence of renal function injury and adverse reactions.