心脏瓣膜置换术中应用1,6-二磷酸果糖的脑保护作用

Cerebral protection of fructose-1,6-diphosphate in patients undergoing cardiac valve replacement

目的探讨1,6-二磷酸果糖(FDP)在心脏瓣膜置换术患者中的脑保护作用。方法体外循环(ECC)下心脏瓣膜置换术的患者30例,随机分为实验组(A组,14例)和对照组(B组,16例)。A组术中将FDP 200mg/kg加入预充液;B组加入等量生理盐水。两组分别于麻醉诱导后5min(T0)以及主动脉开放后5min(T1)、1h(T2)、4h(T3)和24h(T4)采集颈内静脉血,检测血浆S-100蛋白、神经元特异性烯醇化酶(NSE)、丙二醛(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子α(TNF-α)和白细胞介素8(IL-8)水平。结果与T0时比较,T1-T4时A组和B组S-100蛋白、NSE、MDA、SOD、TNF-α及IL-8水平显著增高(P<0.01);T1-T3时,A组S-100蛋白、NSE、TNF-α、IL-8和MDA水平低于B组(P<0.05),SOD活性高于B组(P<0.05)。术后发生认知障碍:A组4例(28.5%),B组8例(50%)(P<0.05)。结论在ECC心脏瓣膜置换术中应用FDP具有一定的脑保护作用,其机制可能与其抑制炎症反应、减轻脑组织缺血再灌注损伤有关。

Objective To explore the cerebral protective of fructose-1, 6-diphosphate（FDP） in the patients undergoing cardiac valve replacement under extracorporeal eireulation（ECC）. Methods Thirty patients undergoing cardiac valve replacement under ECC were randomly divided into 2 groups. FDP 200 mg/kg was added into the prime solution before ECC in 14 cases（group FDP） and sixteen cases of group B were given equal volume of noemal saline as the controls. Blood samples were taken from internal jugular vein at 5 rain after anesthesia（T0）, 5 rain（T1）, 1 h（T2）, 4 h（T3） and 24 h（T4） after aortic declamping. Plasma concentrations of S-100 protein, neuron specific enolase （NSE）, malondialdehyde （MDA）, tumor necrosis factor （ TNF）-α, interleukin （ IL）-8 and the activity of superoxide dismutase （SOD） were measured. The postoperative neurological complications were observed. Results The concentrations of S-100 protein, NSE, TNF-a, MDA, IL-8 and the activity of SOD were all higher at T1-T4 than those at TO in both groups（P〈0. 01）. Compared with group B, the concentrations of S-100, NSE, TNF-α, IL-8 and MDA at T1-T3 were lower, but the activity of SOD was higher, in group A（P〈0. 05）. The postoperative cognitive dysfunction occurred in 4 （28. 5%） cases in group A,which was 8（50%） cases in group B（P〈0. 05）. Conclusion The application of FDP in patients undergoing cardiac valve replacement under ECC can play a role in the cerebral protection, which may be related to its inhibitory effect on inflammatory response and the reduction of the cerebral ischemic-reperfusion injury.