The Protection Effect Of Dexmedetomidine On Myocardium For Off-pump Coronary Artery Bypass Grafting

Objective: The levels of TNF-α, IL-1β, IL-6, IL-10 and c Tn I in serum of the patients for OPCABG were observed during perioperative period in this research to investigate and evaluate the myocardial protection effect of dexmedetomidine(DEX) on myocardium for off-pump coronary artery bypass grafting(OPCABG) and the possible relationship between the protection effect and mitigation inflammatory response.Methods: Sixty patients scheduled for OPCABG, ASA II or III, aged 43~76yr, weighing 50~85kg, LVEF>45% were randomly divided into two groups,the DEX treatment group(group D, administrated with DEX,n=30) and the control group(group C, saline instead,n=30), Blood samples 3ml from central venous were taken respectively for serum separating at the point of administrating with Dexmedetomidine(T0), the beginning of the operation(T1), 5 min after the operation(T2) and 12 h after the operation(T3). The content of TNF-α, IL-1β, IL-6, IL-10 and c Tn I in serum were then detected by double antibodies sandwich-enzymelinked immunosorbent assay(ELISA).Results were expressed as mean ± standard deviation( x ±s), the results between groups were analysised with One-way ANOVA,and the mean inner each group were comparised with paired-samples t test, P values less than 0.05 were considered statistically significant.Results: Age experimental and control groups before surgery, gender, body mass index(BMI), ASA classification, left ventricular ejection fraction(LAEF) and surgical time difference was not statistically significant. For both groups, the levels of TNF-α, IL-1β, IL-6 and c Tn I in serum of patients significantly increased at first and then declined, and all of them increased to the peak at T2 and decreased significantly at T3. The levels of TNF-α and IL-1β were lower than preoperative at T3. At T0 and T1, the levels of TNF-α, IL-1β, IL-6 and c Tn I in serum of patients in both groups had no significant difference(P>0.05), but the levels of TNF-α and c Tn I in serum of Group D were extremely significantly lower than group C at T2 and T3(P<0.05), and the levels of IL-1β in serum of Group D were respectively significantly and extremely significant(P<0.05) lower than group C at T2 and T3(P<0.05), and the levels of IL-6 in serum of Group D were significantly lower than group C at T2 and T3(P<0.05 and P<0.05). The level of IL-10 in serum of patients in both groups increased gradually and at T3 it increased to the peak. At T0 the levels of IL-10 in serum of patients in both groups have no significant difference(P>0.05), and the level of IL-10 in serum of Group D was significantly higher than group C at T1(P<0.05), and at both T2 and T3,the level of IL-10 in serum of Group D was extremely significantly higher than group C(P<0.05).Conclusion: DEX administration preoperative for anesthesia induction achieved a desired effect with more stable hemodynamics and at the same time the levels of TNF-α, IL-1β, IL-6 and c Tn I in serums significantly reduced and the levels of IL-10 in serums increased. DEX may regulated the inflammation from both positive and negative pathway with the mechanism of attenuating the inflammation factors and enhancing the anti-inflammatory factors to inhibit the c Tn I releasing into serum, as a result of relieving inflammatory lesions and the damage on myocardial tissue to protect the myocardium for OPCABG.Right dexmedetomidine hydrochloride reduce perioperative inflammation, to improve off-pump coronary artery disease in patients with coronary artery bypass grafting(OPCABG) perioperative safety is important, at the same time caused by alleviating postoperative systemic inflammatory response syndrome(SIRS) to reduce the risk of postoperative patients with multiple organ dysfunction syndrome(MODS), providing medical reference for clinical anesthesia.