不停跳冠脉搭桥术后认知功能障碍患者C-反应蛋白及IL-6的变化

Postoperative cognitive dysfunction and it's relationship to C-reactive protein and IL-6 in off-pump coronary artery bypass grafting

目的观察不停跳冠状动脉搭桥术(OPCABG)患者早期术后认知功能障碍(POCD)的发生率及在此过程中C-反应蛋白(CRP)与IL-6的变化。方法择期行OPCABG的患者38例,术前1 d和术后7 d进行认知功能测试,以手术前后神经心理学测试(MMSE)评分下降大于等于术前1个标准差评定为POCD,并分为POCD组和非POCD组。于术前、术后24 h和48 h测定血清CRP和IL-6。结果 POCD发生率为36.8%。POCD组术前合并高血压、糖尿病及术后发生并发症的比例均高于非POCD组,但差异无统计学意义(P>0.05)。POCD组术后48 h的CRP及IL-6均高于非POCD组,差异有统计学意义(P<0.05)。结论OPCABG患者POCD有较高的发生率。术后血清CRP及IL-6水平持续增高可能在POCD的发生中有重要作用。

Objective To observe the incidence of postoperative cognitive dysfunction （POCD）＂ and compare the levels of serum CRP and L - 6 between the POCD and non - POCD groups in the patients undergoing off - pump coronary artery bypass graft surgery. Meth- ods Thirty- eight patients undergoing elective off- pump coronary artery bypass graft （OPCABG） surgery were enrolled. Neurocognitive testing was performed before and 7 d after the operation and defining POCD as a 1 SD decline from baseline on neurocognitive assessment. These patients were divided into two groups（POCD group and non- POCD group）. IL- 6 and CRP were measured before operation, 24 h and 48 h postoperatively. Results The experiment was completed in 29 of the patients before discharge. The rate of POCD was found to be 36.8%. No change was found in age and sex, height, weight, educational background between patients with or without POCD. In POCD group, the rate of hypertension, diabetes and the postoperative complications was higher than that in non - POCD group. However, no change was found between two groups. The levels of serum CRP and IL - 6 increased markedly at 24 h and 48 h postoperatively and the high- est concentration was showed at 48 h postoperatively. Patients with POCD had an increase of CRP of a significantly higher magnitude at 48 h postoperatively than those without POCD （ P 〈 0.05 ）. Conclusion This study shows that the incidence of early POCD is quite high in OP- CABG surgery, and the continuous increases of CRP and IL -6 postoperatively play a key role in patients undergoing OPCABG surgery with POCD. Reducing the inflammatory response can be thought as a possible target for the prevention of POCD.