| 王轶芃,刘达琪,周程辉,杨 波,王世磊.右美托咪定联合丙泊酚对HVR患者氧化应激、脑氧代谢指标和细胞焦亡因子的影响[J].,2024,(11):2052-2056 |
| 右美托咪定联合丙泊酚对HVR患者氧化应激、脑氧代谢指标和细胞焦亡因子的影响 |
| Effects of Dexmedetomidine Combined with Propofol on Oxidative Stress, Cerebral Oxygen Metabolism Indexes and Cell Pyroptosis Factors in Patients with HVR |
| 投稿时间：2024-02-27 修订日期：2024-03-21 |
| DOI：10.13241/j.cnki.pmb.2024.11.009 |
| 中文关键词: 右美托咪定 丙泊酚 心脏瓣膜置换 氧化应激 脑氧代谢 细胞焦亡因子 |
| 英文关键词: Dexmedetomidine Propofol HVR Oxidative stress Cerebral oxygen metabolism Cell pyroptosis factors |
| 基金项目:国家自然科学基金面上项目（81970290） |
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| 中文摘要: |
| 摘要 目的：探讨丙泊酚、右美托咪定复合麻醉对体外循环下心脏瓣膜置换（HVR）患者脑氧代谢指标、氧化应激和细胞焦亡因子的影响。方法：选取2021年3月~2022年12月期间在我院择期行体外循环下HVR的136例患者。按照随机数字表法将患者分为对照组（丙泊酚麻醉）和研究组（右美托咪定联合丙泊酚麻醉），各为68例。对比两组血流动力学、氧化应激指标、心肌损伤指标、脑氧代谢指标、细胞焦亡因子和不良反应发生率。结果：开放主动脉后（T1）~术毕（T3）时间点，研究组心率（HR）、平均动脉压（MAP）高于对照组（P<0.05）。术后24 h，研究组超氧化物歧化酶（SOD）高于对照组，丙二醛（MDA）低于对照组（P<0.05）。术后24 h，研究组肌酸激酶同工酶（CK-MB）、N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）低于对照组（P<0.05）。术后24 h，研究组NOD样受体蛋白3（NLRP3）、半胱天冬氨酸蛋白酶1（Caspase-1）、消皮素D（GSDMD）低于对照组（P<0.05）。T1~T3时间点，研究组动脉-颈内静脉血氧含量差（Da-jvO2）、脑氧摄取率（CERO2）高于对照组，颈内静脉血氧饱和度（SjvO2）低于对照组（P<0.05）。两组不良反应发生率组间对比未见差异（P>0.05）。结论：右美托咪定联合丙泊酚可减轻体外循环下HVR患者氧化应激、炎症反应和心肌损伤，改善脑功能。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of propofol and dexmedetomidine combined anesthesia on cerebral oxygen metabolism indexes, oxidative stress and cell pyroptosis factors in patients undergoing cardiac valve replacement (HVR) under cardiopulmonary bypass. Methods: 136 patients who underwent HVR under cardiopulmonary bypass in our hospital from March 2021 to December 2022 were selected. Patients were divided into control group (propofol anesthesia) and study group (dexmedetomidine combined with propofol anesthesia) according to the random number table method, with 68 cases in each group. The hemodynamics, oxidative stress index, myocardial injury index, cerebral oxygen metabolism index, cell pyroptosis factors and incidence of adverse reactions were compared between two groups. Results: Time point after open aorta (T1) to after operation(T3), the heart rate (HR) and mean arterial pressure (MAP) in study group were higher than those in control group (P<0.05). 24 h after operation, the superoxide dismutase (SOD) in study group was higher than that in control group, and the malondialdehyde (MDA) was lower than that in control group (P<0.05). 24 h after operation, creatine kinase isoenzyme (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in study group were lower than those in control group (P<0.05). 24 h after operation, the levels of NOD-like receptor protein 3 (NLRP3), cyptate protease 1 (Caspase-1), megaphin D (GSDMD) in study group were lower than those in control group (P<0.05). T1~T3 time points, the arterial-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction rate (CERO2) in study group were higher than those in control group, and the jugular venous oxygen saturation (SjvO2) was lower than that in control group (P<0.05). There was no difference in the incidence of adverse reactions between two groups (P>0.05). Conclusion: Dexmedetomidine combined with propofol can reduce oxidative stress, inflammatory response and myocardial injury in patients with HVR under cardiopulmonary bypass, and improve brain function. |
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