乌司他丁对心肺转流心内直视术患者认知功能的影响

Effects of ulinastatin on cognitive function of the patients undergoing cardiac surgery with cardiopulmonary bypass

目的研究乌司他丁对体外循环(CPB)下心内直视手术患者认知功能的影响。方法择期CPB下二尖瓣置换术患者24例,随机分为乌司他丁组(U组)和对照组(C组),每组12例。U组给予100万U乌司他丁于体外循环预充液中,C组用生理盐水代替。术前及术后24h行神经功能(MMSE)评分,并于术前(T1)、CPB开始后30min(T2)、CPB结束后1h(T3)、术后6h(T4)及24h(T5)测定血清S-100β蛋白浓度。结果术前与术后24hMMSE评分差值U组低于C组(P<0.05)。C组T2～5血清S-100β浓度高于T1,U组T3～4高于T1,U组T3～5血清S-100β浓度升高幅度低于C组(P<0.05或P<0.01)。结论乌司他丁在一定程度上减轻CPB后认知功能损伤,有一定的脑保护作用。

Objective To investigate the effect of ulinastatin on cognitive function in open heart surgery with cardiopulmonary bypass （CPB） by the mini-mental state examination（MMSE） and S-100β protein concentration monitoring. Methods Twenty-four patients （age 25-62 years old） undergoing elective mitral valve replacement （MVR） under CPB were randomized to receive ulinastatin 1,000,000 units in the primary solution during CPB （group U, n= 12） or no ulinastatin （group C, n= 12）. Every patient underwent MMSE 24h before and after MVR. Blood samples were taken at preoperative （T1）, during CPB 30 min （T2）, lh after termination of CPB （T3）, 6h （T4） and 24h （TS） after operation for determination of blood S-100β concentration. Results The difference in the MMSE scores before and after operation 24h was significantly smaller in group U than that in group C （P〈0.05）. Blood S-100β concentration was significantly increased at T2-5 in group C but only at T3-4 in group U compared to the level at T1 （P〈0.05）. The increase was significantly smaller in Group U than that in group C at T3 -5（P〈0.01）. Conclusion Ulinastatin in the primary solution may benefit from alleviating postoperative cognitive dysfunction indicating its cerebral protective effect.