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摘要：
目的 探讨右美托咪定（dexmedetomidine, Dex）对先天性心脏病新生儿心脏手术的炎性反应、氧化应激、心肌损伤及肺部并发症的影响。 方法 选取广东省妇幼保健院2015年1月至2020年6月收治的76例先天性心脏病新生儿，按随机数字表法将患儿分为观察组和对照组（每组38例）。两组患儿均行CPB下主动脉缩窄矫治术或主动脉弓离断矫治术。观察组在麻醉诱导前予负荷剂量的Dex 0.5 μg/kg，后以0.4 μg·kg−1·h−1的速率持续泵注至手术结束；对照组给予同等容量的生理盐水。记录两组患儿麻醉诱导前（T0）、主动脉开放后1 h（T1）、主动脉开放后6 h（T2）、主动脉开放后12 h（T3）时血清肌钙蛋白I（cardiac troponin I, cTnI）、肌酸激酶同工酶（creatine kinase isoenzymes‑MB, CK‑MB）、IL‑6、C反应蛋白（C‑reactive protein, CRP）、TNF‑α、丙二醛（malondialdehyde, MDA）、皮质醇（cortisol, Cor）水平，术后1 d、术后7 d时肺部并发症发生率，术中情况及术后恢复情况。 结果 两组患儿T1、T2、T3时血清cTnI、CK‑MB、IL‑6、CRP、TNF‑α、Cor水平较T0时升高（P<0.05），T2、T3时血清MDA水平较T0时升高（P<0.05）。观察组T1、T2、T3时血清cTnI、CK‑MB水平低于对照组（P<0.05），T2、T3时血清IL‑6、CRP、TNF‑α、MDA、Cor水平低于对照组（P<0.05）。观察组术后1 d和术后7 d肺部并发症总发生率均低于对照组（P<0.05）。两组患儿CPB时间、主动脉阻断时间比较差异无统计学意义（P>0.05），观察组ICU入住时间、住院时间短于对照组（P<0.05）。 结论 Dex用于新生儿CPB下心脏手术可抑制氧化应激及炎性反应，减轻心肌损伤，促进患儿恢复并减少肺部并发症。
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Abstract: Objective To explore the effect of dexmedetomidine (Dex) on the inflammatory response, oxidative stress, myocardial damage and pulmonary complications in neonatal heart surgery with congenital heart disease. Methods A total of 76 newborns with congenital heart disease admitted to our hospital from January 2015 to June 2020 were divided into observation group and control group according to the random number table method, 38 cases in each group. Both groups of children underwent cardiopulmonary bypass (CPB) correction of aortic coarctation or correction of aortic arch interruption. The observation group was given a loading dose of dexmedetomidine 0.5 μg/kg before induction of anesthesia, and subsequently pumped Dex continuously at a rate of 0.4 μg·kg−1·h−1 until the end of the operation. The control group was given the same volume of normal saline. The cardiac troponin I (cTnI), creatine kinase isoenzymes⁃MB (CK⁃MB), interleukin⁃6 (IL⁃6), C⁃reactive protein (CRP), tumor necrosis factor alpha (TNF⁃α), malondialdehyde (MDA) and cortisol (Cor) were recorded before anesthesia induction (T0), 1 h after opening the aorta (T1), 6 h after opening the aorta (T2), and 12 h after opening the aorta (T3) in the two groups of children.Record the incidence of pulmonary complications at 1 and 7 days after surgery, intraoperative conditions and postoperative recovery in the two groups of children. Results The levels of cTnI, CK‑MB, IL‑6, CRP, TNF‑α, and Cor of children in the serum at T1, T2, and T3 were significantly higher than the level at T0 in two groups (P<0.05); the level of serum MDA of T2 and T3 group was higher than that of T0 group (P<0.05). The serum cTnI and CK‑MB levels at T1, T2, and T3 of the observation group were lower than those levels in control group (P<0.05), and serum levels of IL‑6, CRP, TNF‑α, MDA, and Cor at T2, T3 were all lower than those levels of the control group (P<0.05). The total incidence of pulmonary complications in the observation group at 1 and 7 days after operation were significantly lower than in the control group (P<0.05). There was no significant difference in CPB time and aortic block time between the two groups (P>0.05）, the intensive care unit (ICU) stay time and hospital stay in the observation group were shorter than those patients in the control group (P<0.05). Conclusions Dex used in neonatal CPB cardiac surgery can inhibit oxidative stress and inflammation, reduce myocardial damage, promote the recovery of children and reduce pulmonary complications.
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