Study on the cardiopulmonary protective effect of dexmedetomidine combined with opioids on patients under-going cardiopulmonary bypass surgery during the perioperative period

GONG Zheng; SONG Siming; LU Liuyu; JIANG Yuhua; LI Jun; MA Li

doi:10.3969/j.issn.1674-3806.2024.10.13

Abstract：Objective To observe the cardiopulmonary protective effect of dexmedetomidine combined with opioids on patients undergoing cardiopulmonary bypass surgery during the perioperative period in order to provide clinical guidance for rational application of anesthetic drugs.Methods One hundred and twenty patients who underwent single valve replacement under general anesthesia and hypothermia cardiopulmonary bypass in the People's Hospital of Guangxi Zhuang Autonomous Region from May 2016 to March 2018 were recruited and divided into sufentanil group(S group),fentanyl group(F group),sufentanil+dexmedetomidine group(SD group)and fentanyl+dexmedetomidine group(FD group)by random number table method,with 30 cases in each group.The patients'intraoperative conditions were compared among the four group.The inflammatory factors,creatine kinase isoenzyme-MB(CK-MB)and cardiac troponin Ⅰ(cTnⅠ)levels were detected 1 day before entering the operation room(T0),1 day after operation(T,),3 days after operation(T2),and 7 days after operation(T3).Oxygenation index(OI),alveolar arterial pressure difference[P(A-aDO2)]and the other indexes of lung function were calculated.Results The dosage of sufentanil in the SD group was significantly lower than that in the S group(P＜0.05)and the dosage of fentanyl in the FD group was significantly lower than that in the F group(P＜0.05).The dosages of propofol and midazolam in the SD group were lower than those in the other three groups,and the differences were statistically significant(P＜0.05).At T,to T3 time points,the levels of white blood cell(WBC),percentage of neutrophils(N％),C-reactive protein(CRP)and hypersensitive C-reactive protein(hs-CRP)in the SD group and the FD group were significantly lower than those in the S group and the F group,respectively(P＜0.05).At T,time point,the levels of CRP and hs-CRP in the SD group were significantly lower than those in the FD group(P＜0.05).The levels of WBC,N％,CRP and hs-CRP in the SD group were significantly lower than those in the FD group at T2 and T3 time points(P＜0.05).At T,to T3 time points,the levels of CK-MB and cTnⅠ in the SD group and the FD group were significantly lower than those in the S group and the F group,respectively(P＜0.05).At T1 time point,the level of cTnⅠ in the SD group was significantly lower than that in the FD group(P＜0.05).At T2 time point,the levels of CK-MB and cTnⅠ in the SD group were significantly lower than those in the FD group(P＜0.05).At T3 time point,the level of CK-MB in the SD group was significantly lower than that in the FD group(P＜0.05).Conclusion Dexmedetomidine combined with sufentanil or fentanyl regimen can reduce inflammatory stress response and cardiopulmonary organ function injury,and dexmedetomidine combined with sufentanil regimen is more effective.