| Background and ObjectiveMitral valve stenotic rheumatic heart is currently a common acquired heart disease.The commonly used treatment method is heart valve replacement under cardiopulmonary bypass,but heart surgery can cause myocardial ischemia-reperfusion injury.The possible mechanism of myocardial ischemia-reperfusion injury is related to a large amount of intracellular oxygen free radicals and a large number of inflammatory factors released.Dexmedetomidine hydrochloride is a new type of highly selective ?2 adrenergic receptor agonist,which has sedative,analgesic,anti-anxiety,inhibits sympathetic excitement,reduces stress response,and stabilizes hemodynamics.Moreover,its effect of slowing heart rate is particularly suitable for the heart rate requirements of valvular replacement surgery for mitral stenosis.This trial is intended to study the effects of dexmedetomidine on inflammatory response and myocardial protection in patients with mitral valve stenosis undergoing valve replacement.Materials and methodsPatients with heart disease who underwent cardiopulmonary bypass valve replacement for mitral stenosis from June 2016 to June 2018 were selected.A total of 120 patients who met the selection criteria and were further screened by the exclusion criteria were randomly divided into a test group(dexmedetomidine group)and a control group(saline group),with 60 patients in each group.The test group was treated with dexmedetomidine before anesthesia,and the control group was treated with an equal amount of 0.9%sodium chloride solution before anesthesia.Observe the following indicators:(1)Record the mean arterial pressure(MAP)and heart rate(HR)of T1 before medication,T2 before the start of CPB,T3 after the end of CPB,and T4 after extubation.(2)Peripheral blood was collected before T1,T2 before the start of CPB,T3 after the end of CPB,and T4 after extubation.Serum malondialdehyde(MDA)content was determined by thiobarbituric acid method,SOD vigor,xanthine oxidase method,nitric oxide(NO)concentration was measured by nitrate reductase method,and serum creatine kinase isoenzyme(CK-MB)levels were measured by immunosuppressive method.The levels of cardiac troponin I(cTn-I)were measured by immunochemiluminescence,and serum myeloperoxidase(MPO),endothelin-1(ET-1),and soluble intercellular adhesion molecule-1 were detected by ELISA.(intercellular adhesion mole-eule-1,ICAM-1),interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-?)concentrations.Results1.There was no statistically significant difference between the two groups of patients in terms of sex ratio,age,and recombination(P>0.05).2.Compared with the control group,the patients in the experimental group had higher mean arterial pressure and lower heart rate at three-time points T2,T3,and T4,and the differences were statistically significant(P<0.05).Compared with the time point T1,the patients in the control group T2 The mean arterial pressure decreased and heart rate increased at T3 and T4,and the differences were statistically significant(P<0.05).3.Comparison of oxidative stress indicators at different time points between two groups of patients3.1.Comparison of serum MDA levels ? Within the group,compared with T1,the MDA of patients in the control group and the test group increased at T2,T3,and T4,and the difference was statistically significant(P<0.05);?Comparison between groups,Compared with the MDA at T2,T3 and T4 of the control group at each time point,the MDA in the test group was reduced,and the difference was statistically significant(P<0.05)3.2 Comparison of SOD levels in serum ? Comparison within the group,compared with T1,the SOD expression of patients in the control group and the test group were reduced at T2,T3,and T4,the difference was statistically significant(P<0.05);? between groups Compared with the SOD expression at each time point of T2,T3,and T4 in the control group,the SOD expression in the test group increased,and the difference was statistically significant(P<0.05).4.Comparison of serum inflammatory factor markers at different time points between the two groups of patients4.1 Comparison of NO levels in serum ?Compared within the group,compared with T1,the levels of NO expression at T2,T3,and T4 of patients in the control group and the test group increased,and the difference was statistically significant(P<0.05);? Group Compared with the control group,the expression of NO at the time points of T2,T3 and T4 in the control group was higher than that in the test group,and the difference was statistically significant(P<0.05).4.2 Comparison of serum MPO levels ? Within the group,compared with T1,the MPO expressions of patients in the control group and the test group were increased at T2,T3,and T4,and the difference was statistically significant(P<0.05);? between groups Compared with the MPO expression at each time point of T2,T3,and T4 in the control group,the MPO expression in the test group was reduced,and the difference was statistically significant(P<0.05).4.3 Comparison of ET-1 levels in serum ? Compared with T1,compared with T1,the ET-1 expression of patients in the control group and the test group was increased at T2,T3,and T4,and the difference was statistically significant(P<0.05);Compared between groups,compared with the ET-1 expression at each time point of T2,T3 and T4 in the control group,the expression of ET-1 in the test group was reduced,and the difference was statistically significant(P<0.05).4.4 Comparison of ICAM-1 levels in serum?Comparison within the group.Compared with T1,the ICAM-1 expression of patients in the control group and the test group was increased at T2,T3,and T4,and the difference was statistically significant(P<0.05).? Comparison between the groups.Compared with the ICAM-1 expression at each time point of T2,T3 and T4 in the control group,the expression of ICAM-1 in the test group were reduced,and the difference was statistically significant(P<0.05).4.5 Comparison of IL-6 levels in serum ?Compared with T1,compared with T1,the expression of IL-6 at T2,T3,and T4 in patients in the control group and the test group was increased,and the difference was statistically significant(P<0.05)?Comparison between the groups,compared with the IL-6 expression at each time point of T2,T3 and T4 in the control group,the expression of IL-6 in the test group decreased,and the difference was statistically significant(P<0.05).4.6 Comparison of TNF-? levels in serum ? Compared with the group,compared with T1,the expressions of TNF-? at T2,T3 and T4 were increased in patients in the control group and the test group,and the difference was statistically significant(P<0.05)? Compared between groups,compared with the TNF-?expression at each time point of T2,T3 and T4 in the control group,the expression of TNF-? in the test group was reduced,and the difference was statistically significant(P<0.05).5.Comparison of myocardial injury markers in patients5.1 Comparison of CK-MB levels in serum ?Comparison within the group.Compared with T1,the CK-MB expression of patients in the control group and the test group was increased at T2,T3,and T4,and the difference was statistically significant(P<0.05).?Comparison between the groups,compared with the CK-MB expression at each time point of T2,T3 and T4 in the control group,the CK-MB expression in the test group was reduced,and the difference was statistically significant(P<0.05).5.2 Comparison of serum cTn-I levels ? Comparison within the group.Compared with T1,the cTn-I expression of patients in the control group and the test group increased at T2,T3,and T4,and the difference was statistically significant(P<0.05).;Compared between groups,compared with the cTn-I expression at each time point of T2,T3 and T4 in the control group,the cTn-I expression in the test group decreased,and the difference was statistically significant(P<0.05).ConclusionIn mitral valve stenosis for valve replacement,dexmedetomidine was given intravenously at a load of 0.5 ?g/kg before surgery,and then dexmedetomidine was continuously pumped at 0.5 ?g/kg/h,which can reduce postoperative inflammation.The release of sex factors can inhibit the inflammatory response,reduce the damage of oxidative stress,protect the heart muscle. |
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