广东医学2018，Vol.39Issue(3)：449-453,457,6.
地佐辛联合右美托咪定镇静改善心脏病患者术后认知功能的有效性及安全性
Efficacy and safety evaluation of dezocine combined with dexmedetomidine on postoperative cognitive function in patients of cardiac surgery
摘要
Abstract
Objective To observe the efficacy and safety of diazepam combined with dexmedetomidine on sedation and analgesia in patients undergoing cardiac surgery. Methods Totally 82 patients transferred to ICU after cardiac surgery were enrolled in this prospective study, and randomly divided into experimental group ( n =50, dezocine combined dexmedetomidine) and control group ( n =32, fentanyl combined dexmedetomidine) . Effectiveness indicators, including RR, tracheal intubation time, hemodynamics parameters ( including HR, MAP) , the dose of vasoactive agents, mechanical ventilation time, and the blood-gas analysis results before and 2 hours and 24 hours after extubation, were recorded. Safety indicators, inluding adverse reactions such as bradycardia, nausea, vomiting, decreased blood pressure, muscle tremor, delirium, and et al. , were recorded. Cognitive function, which presented as TNF-α, IL-1, NO, S100β protein, blood oxygen saturation ( SjvO2 ) and middle cerebral artery blood flow peak ( MCA) , were measured before extubation and 2 hours and 24 hours after extubation. The Intelligent Mental State Examination Scale ( MMSE) score were calculated. Results During the period of extubation, there was no significant difference between the two groups in the total amount of vasoactive agents, the time of mechanical ventilation, the incidence of gastrointestinal reactions, the rate of blood pressure drop, the incidence of bradycardia, or the difference in the incidence of fibrillation ( P＞ 0. 05) . There was no significant difference in RASS, heart rate, MAP, blood gas ( PCO2, OI, Lac) and RR between the two groups either( P＞ 0. 05) . The levels of TNF-α, IL-1 and NO in the plasma of the experimental group were significantly lower than those in control group before and 2 hours after extubation ( P＜ 0. 05) , as the peak value of SjvO2 and MCA were significantly higher than those in control group ( P＜ 0. 05) . However, there was no significant difference in them between the 2 groups 24 hours after extubation. There was no significant difference in plasma S100β protein level between the two groups before and 24 hours after extubation ( P＞ 0. 05) , but it was significantly lower in experimental group 2 hours after extubation than that in the control group ( P＜ 0. 05) . The incidence of cognitive dysfunction was 6. 38％ in the experimental group, which was significantly lower than that ( 21. 88％) in the control group ( P＜ 0. 05) . Conclusion Dezocine combined dexmedetomidine sedation in patients for cardiac surgery is safe and effective, and can significantly reduce postoperative cognitive dysfunction.关键词
地佐辛/右美托咪定/心脏术后/认知功能Key words
dezocine/dexmedetomidine/cardiac surgery/cognitive function引用本文复制引用
吴昆鹏,陈莹,言彩红,黄治家,包娟..地佐辛联合右美托咪定镇静改善心脏病患者术后认知功能的有效性及安全性[J].广东医学,2018,39(3):449-453,457,6.基金项目
湖南省卫生计生委科研计划课题(编号:B2016135) （编号:B2016135）
