Effects Of Dexmedetomidine On Plasma Inflammatory Factors And Lung Function In Patients With Cardiac Valve Replacement

Objective:To investigate the changes of ICAM-1,TNF-?,IL-6,IL-8,and OI and RI in the plasma of patients with cardiac valve replacement by the dexmedetomidine,and to explore their effects on inflammatory response and pulmonary function.Methods: According to the principle of randomization,65 patients with valve replacement after cardiopulmonary bypass were selected,which were divided into the control Group C with 33 cases and the dexmedetomidine Group D with 35 cases.Routine monitoring and anesthesia induction in patients after entry,Group C: normal saline with the same capacity in Group D before and during the induction and maintenance of anesthesia;Group D: Intravenous injection of the dexmedetomidine 1?g kg-1(10min)before anesthesia induction,maintaining dose 0.5?g kg-1 h-1 until the end of surgery.Before the drug delivery(T0),the concentrations of TNF-?,IL-6,IL-8,and cell adhesion factor-1(ICAM-1)in plasma were measured by the arterial blood of the patients at the time of the sternum(T1),Downtime(T2)and 24h(T3),and the OI and RI were computed.Record Hemodynamics Index,cardiac rehabilitation,postoperative ICU support time,postoperative extubation time,hospitalization time and pulmonary complications.Results:(1)The clinical data of the two groups were compared: age,weight,sex,preoperative cardiac function grading,aortic occlusion time,flow time,operation time,EEG double frequency index,cardiac relapse,postoperative hospitalization time,postoperative pulmonary complication,postoperative prognosis,The hospitalization expenses were not statistically significant(p?0.05),the extubation time and ICU support time in Group D were shorter than those in Group C,and the difference was statistically significant(p<0.05).(2)Comparison of serum inflammatory factor concentrations in two groups: compared with T0,the T1 and T2 IL-6,IL-8,TNF-? and ICAM-1 of the two groups were gradually elevated,and the difference was statistically significant(p<0.05),and the C group T3 IL-6,IL-8,The TNF-? and ICAM-1 were higher than the T0,and the T3 of the D group was higher than the IL-6,and the difference was statistically significant(TNF-?);Comparison between groups: There was no significant difference of inflammatory factors(T0)between the two groups of patients at p<0.05 Point of the Group D T0,IL-8,TNF-? and ICAM-1 were lower than those in Group C,and the difference was statistically significant(p<0.05).(3)Comparison of respiratory function parameters between the two groups of patients: group comparison: Compared with T0,the two groups of patients T1,T2 point RI gradually increased,and OI gradually decreased,the difference is statistically significant(p<0.05);T3,RI is lower than T1,T2,but higher than T0,and OI is contrary to RI,the difference is statistically significant(p<0.05);group comparison: The two groups of patients T0 point of OI,RI is no significant difference,Group D T1,T2,T3 point RI significantly lower than the C group(p<0.05),while the D group OI is significantly higher than Group C(p<0.05).Conclusion:(1)dexmedetomidine can reduce the concentration of plasma TNF-?,IL-6,IL-8 and ICAM-1 after CPB in patients with cardiac valve replacement,and reduce the systemic inflammatory response,which is beneficial to the recovery of patients.(2)dexmedetomidine can improve the postoperative respiratory function of patients with heart valve replacement,reduce postoperative lung complications,may have a certain protective effect on the lung,the mechanism may be related to the reduction of plasma inflammatory factor concentration.