小牛血清提取物对老年患者术中脑氧代谢和术后认知功能的影响

Effects of a hemoderivative (Actovegin) on the cerebral oxygen metabolism and the postoperative cognitive function in elderly patients

目的探讨小牛血清提取物（爱维治）能否改善老年患者术中脑氧代谢及术后认知功能。方法82名60岁以上老年患者随机分为治疗组和安慰剂组。所有患者于术前2～3d和术后第7d由心理医师进行一次神经心理测验。麻醉诱导后治疗组输注小牛血清提取物（爱维治）1g／250mL，安慰剂组输注生理盐水250mL。于用药前（T1）、用药后2～3h（T2）、出麻醉后恢复室（PACU）时（T3）3个时间点分别同步采集桡动脉和颈静脉球部血样进行血气分析和血糖测定，计算脑血流量／脑氧耗比值（CBF／CMRO2）和脑氧耗／脑糖耗比值（CMRO2／CMRglu）。结果T2时治疗组的CBF／CMRO2较安慰剂组小（P=0．036），两组各时间点的CMRO2／CMRglu无统计学差异。两组简易智力状态检查术后评分与术前相比均无明显改变；在词汇流畅性测验和视觉辨认功能测验中两组术后评分较术前评分明显降低；在数字倒背测验中，安慰剂组术后评分较术前评分低（P=0．045），而治疗组术后评分与术前评分无统计学差异（P=0．083）。两组术后认知功能障碍的发生率无统计学差异（P=0．886）。结论小牛血清提取物（爱维治）能够促进大脑对氧的利用．使老年患者术后某些方面的认知功能障碍有所减轻。

Purpose To investigate the effects of a hemoderivative （Actovegin） on the cerebral oxygen metabolism and the cognitive function after operation in elderly patients. Methods Eighty-two patients aged over 60 years old were randomly divided into two groups： treatment group （n = 40） and placebo group （n = 42）. A battery of 4 neuropsychological tests was administered 2-3 days before and 7 days after surgery 19y an experienced psychometrician who was blinded to treatment group assignments. After induction of anesthesia, patient received intravenously either 250 mL hemoderivative （Actovegin） or 250 mL normal saline as placebo. Blood samples were taken from artery and internal jugular vein simultaneously for blood gas analyses and determination of blood glucose before administration （T1） ,2-3 hours after administration （T2） and just before leaving PACU （T3）. The ratio of cerebral blood flow to cerebral metabolic rate for oxygen（CBF/CMRO2 ） and the ratio of cerebral metabolic rate for oxygen to cerebral metabolic rate for glucose （CMRO2/CMRglu） were calculated. Results Compared with placebo group, CBF/CMRO2 was significantly lower in treatment group 2-3 hours after treatment （P = 0. 036）. However, there were no differences between two groups in CMRO2/CMRglu at any time. When compared with preoperative results, Mini-Mental State Examination （MMSE） scores did not change in both groups and Verbal Fluency test and Visual Functional Association test results decreased significantly in both groups,whereas Backward Digit Span test value decreased significantly only in the placebo group （P = 0. 045） but not in the treatment group （P = 0. 083）. The proportion of patients showing POCD were similar in two groups （P = 0. 886）. Conclusions These data indicate that the hemoderivative （Actovegin） could improve cerebral oxygen utilization during operation and alleviate some kind of cognitive dysfunction after surgery in elderly patients.