高压氧预处理对冠状动脉搭桥手术患者术后早期认知功能的影响

The effects of repeated hyperbaric oxygen preconditioning on early cognitive outcomes in patients undergoing coronary artery bypass graft surgery

目的:探讨手术前重复高压氧(HBO)预处理对冠状动脉搭桥(CABG)手术患者的临床脑保护的效果及应用安全性。方法:将47例拟行择期CABG手术的病人随机分为对照组(n=24)和HBO预处理组(n=23),对照组包括14例接受体外循环(CPB)手术(On-pump)和10例不停跳手术(Off-pump)方式的病人,HBO组CPB手术和Off-pump手术病人分别为14例和9例。HBO组患者于手术前第5天开始给予HBO预处理措施(2.0 ATA,120 min/次,1次/d,连续5 d),对照组不给予HBO预处理。两组患者均于手术前第6天和术后1周进行神经心理学测试评估术后认知功能变化。结果:HBO组患者术后认知功能障碍(POCD)发生率为8.7%,对照组POCD发生率为37.5%,HBO组明显低于对照组(P<0.05)。结论:重复HBO预处理可安全用于心脏外科CABG手术病人,降低POCD发生率,具有一定的脑保护效应。

Objective： To evaluate the safety,feasibility,and beneficial effect of repeated hyperbaric oxygen（HBO） preconditioning as an adjunctive therapy for brain protection in the clinical trial of coronary artery bypass graft（CABG） surgery.Methods： Forty-seven patientsI were prospectively randomly divided into two groups,control group（n=24） and HBO preconditioning group（n=23） before CABG surgery.Control group included 14 patients undergoing on-pump surgery and 10 patients undergoing off-pump surgery.HBO group included 14 patients undergoing on-pump surgery and 9 patients undergoing off-pump surgery,respectively.Patients in HBO group were intermittently exposed to hyperbaric oxygen for 120 minutes at 2.0 ATA,once daily for consecutive 5 d before surgery.Neuropsychometric testing was performed 6 day before and 1 week after surgery.Results： The incidence of post operative cognitive dysfunction（POCD） in control group was higher than that in HBO group（P0.05）.Conclusion： Repeated hyperbaric oxygen preconditioning can reduce the incidence of POCD,and it is feasible and well tolerated in patients undergoing CABG surgery.However,further multicenter randomized trials are needed to clinically evaluate this form of preconditioning modality.