Abstract：
Postoperative neurological deficits remain a concern for patients undergoing cardiac surgeries. Even minor injuries can lead to neurocognitive decline (i.e., postoperative cognitive dysfunction). Dexmedetomidine may be beneficial given its reported neuroprotective effect. We aimed to investigate the effects of dexmedetomidine on brain injury during cardiac surgery anaesthesia. This prospective observational study analysed data for 46 patients who underwent coronary artery bypass graft surgery with extracorporeal circulation between August 2018 and March 2019. The patients were divided into two groups: control (CON) with typical anaesthesia and dexmedetomidine (DEX) with dexmedetomidine infusion. Concentrations of the biomarkers matrix metalloproteinase-12 (MMP-12) and myelin basic protein (MBP) were measured preoperatively and at 24 and 72 h postoperatively. Cognitive evaluations were performed preoperatively, at discharge, and 3 months after discharge using Addenbrooke\'s Cognitive Examination version III (ACE-III). The primary endpoint was the ACE-III score at discharge. Increased MMP-12 and MBP concentrations were observed in the DEX group 24 and 72 h postoperatively. No significant differences in ACE-III scores were observed between the groups at discharge; however, the values were increased when compared with initial values after 3 months (p = 0.000). The current results indicate that the administration of dexmedetomidine as an adjuvant to anaesthesia can increase MMP-12 and MBP levels without effects on neurocognitive outcomes at discharge and 3 months postoperatively.
摘要：
术后神经功能缺损仍然是接受心脏手术的患者的担忧。即使是轻微的伤害也会导致神经认知能力下降(即，术后认知功能障碍)。鉴于右美托咪定的神经保护作用，右美托咪定可能是有益的。目的探讨右美托咪定对心脏手术麻醉中脑损伤的影响。这项前瞻性观察性研究分析了2018年8月至2019年3月期间接受体外循环冠状动脉旁路移植术的46例患者的数据。将患者分为两组：对照组（CON）典型麻醉和右美托咪定（DEX）右美托咪定输注。术前以及术后24和72h测量生物标志物基质金属蛋白酶12（MMP-12）和髓磷脂碱性蛋白（MBP）的浓度。术前进行认知评估，在放电时，出院后3个月使用Addenbrooke认知检查III版（ACE-III）。主要终点是出院时的ACE-III评分。术后24和72h，DEX组MMP-12和MBP浓度升高。出院时两组间ACE-III评分无显著差异;然而,3个月后,与初始值相比,该值增加(p=0.000).目前的结果表明，右美托咪定作为麻醉的佐剂可以增加MMP-12和MBP水平，而不会影响出院时和术后3个月的神经认知结果。
