Clinical efficacy of deximedetomidine in patients undergoing cardiac valve replacement with cardiopulmonary by-pass

ZHAN Chang-chun; WANG Yu-ming

Abstract：Objective To analyzed the effects of dexmedetomidine ( Dex) on the circulation and enhanced recover-y after surgery during cardiopulmonary bypass ( CPB ) in patients undergoing valve replacement .Methods Fifty-two patients scheduled for mitral valve replacement under CPB with general anesthesia and endotracheal intubation ( ASAⅡ~Ⅲ)were randomly divided into two groups, Group D(n=26), in which subjects received Dex(0.5 μg/kg)plus 50 mL normal saline infusion before induction , and intraoperatively continuous infusion of Dex (0.3μg/kg) until the end of sur-gery;and Group C ( control group , n=26 ) , in which normal saline as placebo were given .The mean arterial pressure (MAP), heart rate(HR), pulse oxygen saturation (SpO2), respiratory rate (RR) and the depth of anesthesia (BIS) were recorded and compared;and so were the operation time , CPB time, postoperative recovery time , ICU monitoring time and hospitalization stay.During the follow-ups on the 1st, 3rd and 7th day, the MMSE were recorded.Results There was no significant difference in MAP between the two groups before surgery (P>0.05), while it was significantly lower in Group D during and after operation [ ( 71.16 ±6.54 ) mmHg and ( 78.02 ±5.48 ) mmHg, respectively ] than Group C (P<0.05).So were the HRs during and after operation in Group D [(64.32 ±5.18)bpm and (72.10 ±6.33)bpm, re-spectively, P<0.05].The BIS in Group D (45.28 ±5.31) was significantly lower than that in Group C (P<0.05). The usage of propofol during induction , the total amounts of propofol and sufentanil [(0.74 ±0.12)mg/kg, (358.24 ± 67.43)mg/kg and (17.94 ±3.02)μg/kg, respectively] were significantly lower than in those in Group C (P<0.05). The incidence of hypertension and heart rate adverse reaction in Group D (7.70%) was lower than that in Group C (P>0.05).The postoperative recovery time, duration of ICU and hospital stay in Group D [(3.47 ±1.21)h, (4.71 ±0.54) d and (11.43 ±3.20)d, respectively] were significantly shorten than Group C (P<0.05).The MMSE scores in the two groups after surgery were significantly lower than before surgery (P<0.05).The MMSE scores on the 3rd and the 7th day in Group D (26.34 ±1.54 and 27.54 ±2.11, respectively) were significantly higher than those in Group C (P<0.05). Conclusion The application of Dex during induction and general anesthesia for CBP operation is conducive to anesthesia induction and operation cycle stability , shorten the recovery time and hospital stay , conducive to the rehabilitation of the patients after surgery , reduces the ICU and hospital stay , alleviates postoperative cognitive dysfunction in patients .