低温复合右美托咪定对体外循环下心脏手术患者氧化应激的影响

doi:10.3969/j.issn.1006-5725.2024.24.014

Abstract

Abstract:

Objective To study the effects of different extracorporeal circulation temperature combined with dexmedetomidine on oxidative stress in patients undergoing cardiac surgery under cardiopulmonary bypass. Methods 240 patients who underwent cardiac surgery under cardiopulmonary bypass were selected from June 2021 to June 2024. The patients were 50 to 75 years old and did not have severe hepatic or renal insufficiency. The Mini-Mental State Examination was completed 1 day before the operation. Patients were routinely established for cardiopulmonary bypass. Patients were randomly divided into four groups （n = 55）： hypothermia + normal saline group （L0）， hypothermia + dexmedetomidine group （L1）， hyperthermia + normal saline group （H0） and hyperthermia + dexmedetomidine group （H1）. The nasopharyngeal temperature was maintained at （30 ± 1）℃ in the hypothermia group and （33 ± 1）℃ in the high-temperature group during the reflux period. Dexmedetomidine injection was intravenously injected at 1 μg/kg 10 minutes before anesthesia in L1 and H1 groups， and pumped continuously at a rate of 0.5 μg/（kg·h） until the end of surgery. L0 and H0 groups were given equal volume of normal saline until the end of operation. 5 mL of central venous blood was collected before the beginning of anesthesia （T1）， at the end of surgery （T2）， 24 h （T3） and 48 h（T4） after surgery， and serum neuron specific enolase （NSE）， interleukin-6 （IL-6） and tumor necrosis factor -α（TNF-α） levels were detected by ELISA. The levels of superoxide dismutase （SOD） and malondialdehyde （MDA） in serum were determined by xanthine oxidase method and thiobarbituric acid method. The Confusion Assessment Method-ICU was used to evaluate the occurrence of POD. Results 220 patients were finally enrolled， including 81 patients in POD group， with an incidence of 36.8%. Compared with NPOD group， the concentrations of NSE， IL-6， TNF-ɑ and MDA in POD group were increased， while the concentration of SOD was decreased.Compared with L0 group， the concentrations of NSE， IL-6， TNF-ɑ and MDA were decreased and the concentration of SOD increased in L1 group.Compared with H0 group， NSE， IL-6， TNF-ɑ and MDA concentrations in H1 group were decreased， while SOD concentration was increased.Compared with L0 group， concentration of NSE， IL-6， TNF-ɑ and MDA increased， while the concentration of SOD decreased in H0 group. Compared with L1 group， concentration of NSE， IL-6， TNF-ɑ and MDA increased， while the concentration of SOD decreased in H1 group. Conclusion Hypothermia combined with dexmedetomidine during cardiopulmonary bypass can reduce oxidative stress response and POD in patients.

Key words: cardiopulmonary bypass, hypothermia, dexmedetomidine, oxidative stress, inflammatory reaction

CLC Number:

R614

Peng SUN,Zhaojin JIA,Xiuhua LI,Xiaowei CHEN,Runsheng WEI,Yantao JIN,Jiantao. JIN. The effects of different extracorporeal circulation temperature combined with dexmedetomidine on oxidative stress in patients undergoing cardiac surgery under cardiopulmonary bypass[J]. The Journal of Practical Medicine, 2024, 40(24): 3521-3526.

Figures/Tables 12

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

Tab.8

Tab.9

Tab.10

Tab.11

Tab.12

References 21

1	MIN Z， MING L， SIMIN Y，et al. Fish oil omega-3 Fatty Acids Alleviate Postoperative delirium-like Behavior in aged mice by Attenuating Neuroinflammation and Oxidative Stress［J］.Neurochem Res，2024，49（1）：157-169. doi:10.1007/s11064-023-04020-9 doi: 10.1007/s11064-023-04020-9
2	POON W， LING R， YANG I，et al. Dexmedetomidine for adult cardiac surgery： a systematic review， meta-analysis and trial sequential analysis［J］.Anaesthesia，2023，78（3）：371-380. doi:10.1111/anae.15947 doi: 10.1111/anae.15947
3	ZHANG D， LI D， WANG X， et al.Urine Proteomic Signatures of Mild Hypothermia Treatment in Cerebral Ischemia-Reperfusion Injury in Rats［J］. Cell Mol Neurobiol，2024，44（1）：49. doi:10.1007/s10571-024-01483-4 doi: 10.1007/s10571-024-01483-4
4	詹峰，宋维，欧阳艳红，等. 右美托咪定联合亚低温对心脏骤停后综合征患者血清神经元特异性烯醇化酶和S100β蛋白的影响及预后评估［J］. 临床急诊杂志， 2022，23（3）： 183-187.
5	李亚斌，尚金星，赵志煌，等. 亚低温结合右美托咪定治疗重型颅脑创伤患者影响研究［J］. 创伤与急危重病医学，2021，9（6）：488-490.
6	MIRANDA F， GONZALEZ F， PLANA M，et al. Confusion Assessment Method for the Intensive Care Unit （CAM-ICU） for the diagnosis of delirium in adults in critical care settings［J］. Cochrane Database Syst Rev，2023，11（11）：CD013126. doi:10.1002/14651858.cd013126.pub2 doi: 10.1002/14651858.cd013126.pub2
7	范晓珍，郎志斌，周俊辉. 体外循环下心脏瓣膜置换术患者术后谵妄与外周血单个核细胞焦亡的关系［J］. 中华麻醉学杂志，2021，41（11）：1298-1302.
8	XIE X， SHEN Z， HU C， et al. Dexmedetomidine Ameliorates Postoperative Cognitive Dysfunction in Aged Mice［J］. Neurochem Res， 2021， 46（9）： 2415-2426. doi:10.1007/s11064-021-03386-y doi: 10.1007/s11064-021-03386-y
9	LI K， WANG J， CHEN L， et al. Netrin-1 Ameliorates Postoperative Delirium-Like Behavior in Aged Mice by Suppressing Neuroinflammation and Restoring Impaired Blood-Brain Barrier Permeability［J］. Front Mol Neurosci，2022， 14（1）：14：751570. doi:10.3389/fnmol.2021.751570 doi: 10.3389/fnmol.2021.751570
10	ILARIA M， ELISABETTA Z， CECILIA S，et al. The landscape of cognitive impairment in superoxide dismutase 1-amyotrophic lateral sclerosis［J］. Neural Regen Res，2023，18（7）：1427-1433. doi:10.4103/1673-5374.361535 doi: 10.4103/1673-5374.361535
11	MYPINDER S， SOPHIE S， VERONICA H，et al.Neuroinflammation and the immune system in hypoxic ischaemic brain injury pathophysiology after cardiac arrest［J］. J Physiol，2024，602（21）：5731-5744. doi:10.1113/jp284588 doi: 10.1113/jp284588
12	LIM J， KER C， LAI N， et al. Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation［J］. Cochrane Database Syst Rev，2024，5（5）：CD012361. doi:10.1002/14651858.cd012361.pub2 doi: 10.1002/14651858.cd012361.pub2
13	葛亮，冷玉芳，张鹏，等. 右美托咪定通过激活PI3K/AKT信号通路对前列腺素诱导分娩窒息子鼠氧化应激和炎症水平的影响及脑保护机制［J］. 实用医学杂志， 2023，39（6）： 688-695.
14	GUO B， CHEN C， YANG L， et al. Effects of dexmedetomidine on postoperative cognitive function of sleep deprivation rats based on changes in inflammatory response［J］. Bioengineered，2021，12（1）：7920-7928. doi:10.1080/21655979.2021.1981757 doi: 10.1080/21655979.2021.1981757
15	JIANG L， DONG R， XU M， et al.Inhibition of the integrated stress response reverses oxidative stress damage-induced postoperative cognitive dysfunction［J］. Front Cell Neurosci， 2022，16：992869. doi:10.3389/fncel.2022.992869 doi: 10.3389/fncel.2022.992869
16	SONG X， CHEN L， YANG S， et al.Therapeutic effect of sub-hypothermic antegrade machine perfusion on brain injury in a pig model of traumatic shock［J］. Asian J Surg，2024，47（5）：2447-2448. doi:10.1016/j.asjsur.2024.01.116 doi: 10.1016/j.asjsur.2024.01.116
17	ZHANG S， ZHANG X， ZHONG H， et al. Hypothermia evoked by stimulation of medial preoptic nucleus protects the brain in a mouse model of ischaemia［J］. Nat Commun，2022，13（1）：6890. doi:10.1038/s41467-022-34735-2 doi: 10.1038/s41467-022-34735-2
18	HUGHES G C， CHEN E P， BROWNDYKE J N， et al. Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest Trial （GOT ICE）： A Randomized Clinical Trial Comparing Outcomes After Aortic Arch Surgery ［J］.Circulation，2024，149（9）：658-668. doi:10.1161/circulationaha.123.067022 doi: 10.1161/circulationaha.123.067022
19	GRIGORE A， MATHEW J， GROCOTT H， et al. Prospective randomized trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery［J］. Anesthesiology， 2001， 95（5）： 1110-1119. doi:10.1097/00000542-200111000-00014 doi: 10.1097/00000542-200111000-00014
20	李磊，徐孟辉，姜文剑，等. 不同类型低温体外循环对比的实验研究［J］. 心肺血管病杂志，2020，39（2）：201-207.
21	HASHIYA M， OKUBO Y， KATO T， et al. Effects of Dexmedetomidine on Brain and Inflammatory Outcomes In Pediatric Cardiac Surgery： A Systematic Review and Meta-Analysis of Randomized Controlled Trials［J］. J Cardiothorac Vasc Anesth，2023，37（6）：1013-1020. doi:10.1053/j.jvca.2023.02.013 doi: 10.1053/j.jvca.2023.02.013

组别	年龄/岁	BMI/ （kg/m² ）	性别/例		ASA分级/例
组别	年龄/岁	BMI/ （kg/m² ）	男	女	Ⅱ级	Ⅲ级
L0组	65.4 ± 4.9	20.4 ± 2.3	25	30	31	24
L1组	65.7 ± 5.3	20.3 ± 1.9	31	24	29	26
H0组	64.3 ± 5.2	20.3 ± 4.7	22	33	34	21
H1组	64.3 ± 4.5	20.2 ± 2.0	29	26	33	22
χ²/F值	1.193	0.070	3.548		1.099
P值	0.313	0.976	0.315		0.777

组别	手术时间/h	转机时间/h	入量/mL	尿量/mL
L0组	5.31 ± 1.18	1.65 ± 0.35	658 ± 41	358 ± 36
L1组	5.24 ± 1.16	1.61 ± 0.33	662 ± 45	364 ± 39
H0组	5.27 ± 1.13	1.64 ± 0.35	655 ± 42	361 ± 40
H1组	5.36 ± 1.12	1.67 ± 0.36	657 ± 41	357 ± 42
F值	0.131	0.212	0.258	0.433
P值	0.942	0.888	0.856	0.730

组别	例数	T1	T2	T3	T4
NPOD组	139	5.49 ± 1.72	16.89 ± 4.51	20.64 ± 5.38	10.86 ± 2.45
POD组	81	5.77 ± 1.64	19.01 ± 4.76^?	23.71 ± 5.28^?	11.79 ± 2.65^?
t值		-1.270	-3.225	-4.122	-2.579
P值		0.206	0.002	< 0.001	0.011

组别	例数	T1	T2	T3	T4
NPOD组	139	1.38 ± 0.35	23.03 ± 7.31	36.20 ± 8.87	28.76 ± 7.24
POD组	81	1.37 ± 0.32	27.48 ± 6.88^?	41.96 ± 7.11^?	32.04 ± 6.73^?
t值		0.212	-4.519	-4.988	-3.388
P值		0.832	< 0.001	< 0.001	0.001

组别	例数	T1	T2	T3	T4
NPOD组	139	23.66 ± 4.47	38.09 ± 8.17	49.46 ± 8.69	44.57 ± 9.12
POD组	81	23.50 ± 4.61	44.07 ± 8.92^?	54.76 ± 8.75^?	47.49 ± 8.44^?
t值		0.250	-4.940	-4.342	-2.394
P值		0.803	< 0.001	< 0.001	0.018

The effects of different extracorporeal circulation temperature combined with dexmedetomidine on oxidative stress in patients undergoing cardiac surgery under cardiopulmonary bypass

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 12

References 21

Related Articles 15

Recommended Articles

Metrics

Comments

组别	例数	T1	T2	T3	T4
NPOD组	139	32.28 ± 6.10	54.25 ± 11.85	69.99 ± 10.64	61.67 ± 8.97
POD组	81	31.71 ± 6.91	47.85 ± 10.25^?	63.89 ± 10.30^?	58.34 ± 8.61^?
t值		0.614	4.210	4.188	2.710
P值		0.540	< 0.001	< 0.001	0.007

组别	例数	T1	T2	T3	T4
NPOD组	139	12.18 ± 2.61	5.24 ± 2.44	3.03 ± 2.14	7.16 ± 2.30
POD组	81	11.78 ± 2.34	6.84 ± 2.73^?	4.71 ± 2.29^?	8.51 ± 2.51^?
t值		1.163	-4.323	-5.338	-3.934
P值		0.246	< 0.001	< 0.001	< 0.001

组别	T1	T2	T3	T4
L0组	5.7 ± 1.7	16.7 ± 3.2	19.8 ± 3.6	10.3 ± 2.4
L1组	5.5 ± 1.6	13.4 ± 2.4^?	15.3 ± 2.1^?	9.8 ± 1.3^?
H0组	5.6 ± 1.8	22.3 ± 4.2^?	28.2 ± 3.3^?	13.1 ± 2.9^?
H1组	5.5 ± 1.7	18.3 ± 3.8^#△	23.6 ± 2.7^#△	11.7 ± 1.9^#△
F值	0.316	62.810	178.347	25.879
P值	0.814	< 0.001	< 0.001	< 0.001

组别	T1	T2	T3	T4
L0组	1.4 ± 0.3	21.5 ± 4.9	38.3 ± 4.8	27.8 ± 4.3
L1组	1.5 ± 0.4	18.4 ± 4.1^?	27.6 ± 4.1^?	22.5 ± 4.2^?
H0组	1.3 ± 0.3	32.3 ± 6.4^?	45.7 ± 6.8^?	37.9 ± 5.1^?
H1组	1.4 ± 0.3	26.5 ± 5.6^#△	41.7 ± 6.3^#△	31.6 ± 4.5^#△
F值	0.308	71.827	104.264	110.621
P值	0.820	< 0.001	< 0.001	< 0.001

组别	T1	T2	T3	T4
L0组	22.5 ± 4.6	37.6 ± 6.5	47.8 ± 7.4	42.9 ± 7.6
L1组	23.7 ± 4.3	33.4 ± 6.3^?	44.6 ± 6.3^?	37.7 ± 5.5^?
H0组	24.6 ± 4.4	48.7 ± 7.6^?	59.2 ± 7.5^?	52.1 ± 7.4^?
H1组	23.6 ± 4.5	41.5 ± 7.3^#△	54.1 ± 7.2^#△	49.9 ± 7.2^#△
F值	2.238	49.275	47.027	49.591
P值	0.085	< 0.001	< 0.001	< 0.001

组别	T1	T2	T3	T4
L0组	32.5 ± 6.6	54.2 ± 6.7	71.9 ± 8.3	62.6 ± 7.1
L1组	31.6 ± 6.5	66.8 ± 7.8^?	77.6 ± 8.5^?	68.6 ± 7.4^?
H0组	31.7 ± 6.3	41.1 ± 5.2^?	56.8 ± 6.3^?	52.9 ± 6.4^?
H1组	32.6 ± 6.4	45.6 ± 5.6^#△	64.7 ± 7.3^#△	57.7 ± 6.3^#△
F值	0.331	170.453	77.122	53.589
P值	0.803	< 0.001	< 0.001	< 0.001

组别	T1	T2	T3	T4
L0组	11.6 ± 2.5	4.4 ± 1.1	2.4 ± 0.8	6.4 ± 1.1
L1组	12.5 ± 2.6	3.3 ± 0.9^?	1.4 ± 0.6^?	5.4 ± 0.9^?
H0组	12.6 ± 2.4	9.4 ± 1.8^?	6.4 ± 1.7^?	10.4 ± 2.1^?
H1组	11.4 ± 2.5	6.4 ± 1.3^#△	4.4 ± 1.6^#△	8.4 ± 1.6^#△
F值	1.326	223.878	173.621	120.311
P值	0.267	< 0.001	< 0.001	< 0.001

[1]	Jinyan FAN,Lili CHEN,Su LIU,Chuanwu ZHANG,Zhen′ang MENG,Guanglei. WANG. Effect of nalbuphine hydrochloride combined with dexmedetomidine on post⁃operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery [J]. The Journal of Practical Medicine, 2024, 40(7): 996-1001.
[2]	Xiangmi HUANG,Ying CHEN,Deming WANG,Kunpeng WU. Effect of desflurane post⁃conditioning on myocardial protection in patients undergoing cardiac surgery under cardiopulmonary bypass [J]. The Journal of Practical Medicine, 2024, 40(6): 838-843.
[3]	Kanglin CAI,Jinkai ZHANG,Liangdi RAN,Dajun HU,Zhitao FENG,Huilian. HUANG. Research progress on antidepressant pharmacological effects and mechanisms of Bupleuri Radix⁃Paeoniae Radix Alba herb⁃pair [J]. The Journal of Practical Medicine, 2024, 40(4): 447-452.
[4]	Jianqiang ZENG,Zhaoying ZHONG,Lei YUAN,Donglan. PENG. Effects of different doses of dexmedetomidine combined with ropivacaine TPVB under ultrasound guidance on vital signs and stress response of patients undergoing thoracoscopic surgery under general anesthesia [J]. The Journal of Practical Medicine, 2024, 40(24): 3527-3533.
[5]	Maoqing WANG,Wenhui LI,Meihuang. CAI. Effect of compound Xueshuantong combined with viaminate of oral lichen planus complicated with chronic periodontitis [J]. The Journal of Practical Medicine, 2024, 40(21): 3076-3081.
[6]	Tianyue YU,Qian GUO,Hao HU,Yujing SU,Jianhua CHEN. Advances in oxidative stress⁃related pathways with diagnostic and predictive value in schizophrenia [J]. The Journal of Practical Medicine, 2024, 40(20): 2935-2940.
[7]	Jieqiong LIU,Yali YAO,Qian SUI,Ke LI,Fang HUANG,Yongqing. CAO. Based on the novel anti-heart failure drug ARNI， the mechanism of prevention of cardiotoxicity caused by anthracycline antitumor drugs was discussed [J]. The Journal of Practical Medicine, 2024, 40(2): 188-194.
[8]	Zhiyan XU,Weiyuan CHEN,Weifeng. YAO. Mechanism and research progress of dexmedetomidine in improving perioperative neurocognitive disorder in frail elderly patients [J]. The Journal of Practical Medicine, 2024, 40(17): 2503-2507.
[9]	Ganggang LU,Shenglong LI,Yongqiang ZHAO,Yunpeng JIA,Yonglin LIANG,Yuanbo. ZHAO. Research progress on the correlation between oxidative stress and ferroptosis in diabetic impotence [J]. The Journal of Practical Medicine, 2024, 40(16): 2229-2235.
[10]	Yunlong SUN,Zhe MENG,Xijia WANG,Lu. GAO. Liraglutide ameliorates high glucose⁃induced endothelial cell injuryvia Nrf2 [J]. The Journal of Practical Medicine, 2024, 40(15): 2051-2055.
[11]	Yong YANG,Renjun CHEN,Jianling GE,Wei. WANG. The protective effect of dexmedetomidine on sevoflurane⁃induced cognitive impairment based on the Wnt/β⁃catenin signaling pathway [J]. The Journal of Practical Medicine, 2024, 40(15): 2063-2068.
[12]	Chun LONG,Hongying BI,Changzhen YANG,Jiakai WANG,Yan TANG,Xu. LIU. Emodin upregulates the Sirt2 to attenuate LPS-induced oxidative stress response in RAW264.7 cells [J]. The Journal of Practical Medicine, 2024, 40(13): 1785-1790.
[13]	Di WANG,Jian YANG,Xiang HE. Dexmedetomidine alleviates propofol induced learning and memory impairment in rats at developmental stage by regulating AKAP150 [J]. The Journal of Practical Medicine, 2024, 40(12): 1619-1624.
[14]	Wanyong ZHAO,Xiaopeng SUN,Jingjing WANG,Xiaohong LI,Hongtao SUN. Effects of targeted temperature management based on different durations after traumatic brain injury in rats [J]. The Journal of Practical Medicine, 2024, 40(12): 1625-1630.
[15]	Ruyue XUE,Yuexian LI,Defeng. SUN. Research progress on stellate ganglion block improving postoperative cognitive dysfunction [J]. The Journal of Practical Medicine, 2024, 40(11): 1500-1504.