参附注射液预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响

Effects of Preconditioning and Postconditioning with Shenfu Injection on Cognitive Function in Patients after Valve Replacement under Cardiopulmonary Bypass

目的观察参附注射液(SFI)预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响。方法32例体外循环下行心脏瓣膜置换术患者,年龄25～54岁,心功能Ⅱ～Ⅲ级,随机分为4组,每组8例。E1组在气管插管后主动脉阻断前泵注SFI1mL/kg;E2组在开放主动脉后泵注SFI1mL/kg;E3组分别于主动脉阻断前和开放主动脉后泵注SFI0.5mL/kg;C组为对照组,在气管插管后输注等量生理盐水1mL/kg。在气管插管后(T1)、体外循环转机10min(T2)、体外循环低温恒温期(T3)、复温至33℃(T4)、体外循环停机(T5)、体外循环结束后1h(T6)6个时间点采集静脉血(颈内静脉球部置管)进行血浆S100β蛋白ELISA法测定;采用简易智力状态评价量表(MMSE),于患者术前1天,术后第1天、第2天及第7天共4次评分。结果E1、E2、E3组血浆S100β蛋白含量上升幅度小于C组(P<0.05),且在T6时刻E3组中含量最低,差异有统计学意义(P<0.05);术后1周认知功能下降的发生率C组最高(P<0.05)。结论SFI能降低血浆中S100β蛋白含量,维持血脑屏障结构和功能稳定,有利于患者术后神经功能恢复,有较好的脑保护作用,且采取主动脉阻断前及开放主动脉后分别泵注0.5mL/kg的方法效果最明显。

Objective To investigate the effects of preconditioning and postconditioning with Shenfu Injection （SFI） on cognitive function in patients after valve replacement under extra-corporeal circulation. Methods Thirty-two patients prepared to receive valve replacement, aged 25-54 years, with heart function of Ⅱ-Ⅲ level, were randomly assigned to four groups, eight in each group. Patients in group E1 received SFI 1 mL/kg after intubation and before blocking the aorta; patients in group E2 received SFI 1 mL/kg after opening the aorta;patients in group E3received SFI 0.5 mL/kg twice, at before blocking and after opening the aorta, respectively; and patients in group C received 1 mL/kg normal saline after intubation for control. All the medication was infused via pump. Venous blood samples were taken from the internal jugular venous bulb cannula for detecting plasma S100β protein by ELISA at 6 different time points, i.e. after trachea intubation （T1）, 10 min after cardiopulmonary bypass （CPB, T2） , hypothermia stabilizing stage （T3） , re-warming to 33℃（3 （T4） , ending CPB （T6） and 1 h after ending CPB （T6）. And patients＇ cognitive function was assessed for 4 times with mini-mental state examination （MMSE） scale, at the day before operation, and 1, 2, 7 days after operation. Results The elevation of S100β plasma protein was lesser in the three E groups than that in group C （P〈0.05）, and the lowest level was shown at T8 in Group E3（P〈0.05）. The highest incidence of cognitive dysfunction occurred in Group C one week after operation （ P 〈 0. 05）. Conclusion SFI may reduce the plasma level of S100β protein, maintain stable the structure and function of blood-brain barrier, it is favorable to the post-operational recovery of neurological function of patients, showing good brain protective effect. The optimal effect could be obtained by pump infusion of 0.5 mL/kg of SFI before aortic blocking and after aortic opening.