体外循环诱发炎性反应与患者术后认知功能障碍的关系

Relationship between inflammatory response induced by cardiopulmonary bypass and postoperative cognitive dysflmction

目的 探讨体外循环（CPB）诱发炎性反应与患者术后认知功能障碍（POCD）的关系.方法 择期CPB下心脏瓣膜置换手术的患者25例,随机分为2组：对照组（C组,n=12）和乌司他丁组（U组,n=13）.两组麻醉诱导、麻醉维持及体外循环方法相同.U组麻醉诱导后立即静脉注射乌司他丁1.2万U/kg,CPB预充液中加入乌司他丁0.6万U/kg,主动脉开放前5 min体外循环中加入乌司他丁0.6万U/kg,C组给予等容量生理盐水.分别于麻醉诱导后切皮前、CPB结束时、术后24 h时采 集外周静脉血样,测定血浆IL-6浓度及外周血中性粒细胞NF-kB表达水平.分别于术前、术后3、7 d时测试认知功能,记录POCD发生情况.结果 与C组比较,U组血浆IL-6浓度和中性粒细胞NF-kB表达降低（P〈0.05或0.01）,POCD发生率差异无统计学意义（P〉0.05）.结论 CPB诱发炎性反应与患者POCD发生无关.

Objective To examine the relationship between inflammatory response induced by cardiopulmonary bypass and postoperative cognitive dysfunction.Methods Twenty-five patients undergoing elective cardiac valve replacement under cardiopulmonary bypass were randomly divided into two groups：ulinastatin group（group U,n=13） and control group（group C,n=12）.In group U,ulinastatin 12 000 U/kg Was given intravenously immediately after induction of anesthesia,6 000 U/kg ulinastatin Was added to the priming solution,and 6000 U/kg ulinastatin was given at 5 min before the aortic decamping.In group C,normal saline was given instead of ulinastatin.Venous blood samples were taken after induction of anesthesia,at the end of CPB,and 24 h after operation for determination of plasma IL-6 concentration and neutrophils NF-kB expression.The cognitive function of the patients was evaluated by Mini-Mental State Examination（MMSE） before and 3 d,7 d after operation.Results The concentraion of IL-6 and neutrophils NF-kB expression were lower in group U than in group C（P〈0.05 or 0.01）.There wag no significant difference in the incidence of postoperative cognitive dysfunction between group C and U.Conclusion Inflammatory response induced by cardiopulmonary bypass is not related to postoperative cognitive dysfunction.