| Objective: This study observes Dexmedetomidine’s (DEX) influence oninflammatory reaction in patients with heart valve replacement surgery undercardiopulmonary bypass (CPB), to explore effectiveness and clinical significance ofDEX for such surgeries.Methods: Selecting30patients undergoing elective open-cardiac valvereplacement surgery with CPB, inclusion criteria: age20to65years old, male orfemale, ASA classification is grade Ⅱor grade Ⅲ, no heart block, left ventricularejection fraction above50%, no other serious medical complications. They wererandomly devided into two groups: control group (Group C, n=15) andDexmedetomidine group (Group D, n=15). We administered Midazolam (0.1mg/kg), Vecuronium (0.12mg/kg), Sufentanil (1to2g/kg) and Propofol (0.5to1.0mg/kg) intravenously in induction of anesthesia, while conventional arteriovenousmonitoring is got. During operation, intravenous infusion of Propofol, Sufentanil,and Vecuronium Bromide and intermittent inhalation of small doses of Sevofluranewere applied to maintenance of anesthesia. Before incision, DEX in continuousinfusion were applied in Group D(0.5μg/kg h) until the end of surgery, while thesame dose of saline in Group C. We, collected blood in central veins at5timepoints: after induction of anesthesia (T1),10minutes after the shutdown of CPB(T2),6h (T3),12h (T4),24hours (T5)5time points, respectively, thendetected their concentrations of TNF-α, IL-10, SOD and MDA. Besides, all patients’sufentanil，extubation time and ICU staying time were observed and recorded.Results: TNF-α： The concentrations of TNF-α had no significant differencebetween two groups at time T1(p>0.05), But in Group D, TNF-α concentrationswere higher than that in Group C at time T2, T3, T4, T5(P <0.05).In every group,TNF-α concentrations at time T1were increased significantly than that at time T2,T3, T4, T5(P <0.05), except at time T4, when TNF-α conce-ntrateons of GroupD were higher than that in at time T1. Besides, the level of TNF-α zconcentrationsreached the highest at time T2in both groups. IL-10: In both groups, IL-10concentrations increased significantly at time T2,T3, T3, T4, T5than that at time T1（P＜0.05）, and it reached the highest at timeT2. Besides, the lowest level of TNF-α concentration was got at time T2inroupD. But there were no obvious difference of it between two groups at time T1, T2,T3（P>0.05） while IL-10concentrations of Group D decreased significantly at timeT4, T5than that of Group C (P <0.05).SOD: The levels of IL-10concentrations of Group D at every recorded timepoint showed no significant difference (P <0.05), and in Group C, a marked differ-ence was showed only between at time T4and T1(T4>T1, P<0.05).MDA: In Group C, MDA concentrations increased significantly at time T1,T2, T3, T5than that at time T1（P<0.05),and it reached the highest at time T2, thenit gradually reduced to the lowest at time T4. While in Group D, it is only at time T2when MDA levels increased significantly than that at time T1(P <0.05).Comparedwith Group C, MDA levels of Group D were significantly lower at time T3, T4, T5.No significant difference in MDA levels were found between the two groups at timeT1and T2.In addition, our study showed that extubation time and the ICU staying timeof Group D were both shorter comparing with Group C, the difference was statis-tically significant (P <0.05)Conclusions：Intraoperative intravenous infusion of DEX (0.5μg/kg h) canreduce the extent of the inflammatory response in patients with heart valvereplacement surgery under cardiopulmonary bypass (CPB), and make extubationtime early, so the patient seems to be beneficial from it. |
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