远程缺血预处理对体外循环心脏手术患者脑损伤的保护作用

Protective effects of remote ischemic preconditioning on cerebral injury in cardiac operation with cardiopulmonary bypass

目的:探讨远程缺血预处理(RIPC)对体外循环心脏手术患者脑损伤的保护作用。方法:66例行体外循环心脏手术患者随机分为远程缺血预处理(实验)组34例、非远程缺血预处理(对照)组32例,均采用丙泊酚全凭静脉麻醉,于术前和术后24h检测两组患者颈静脉血乳酸(Lac)、谷氨酸(Glu)与S-100β蛋白(S100β)含量;术前和术后72h采用简易智力状态检查(MMSE)评估认知功能。结果:两组术前血清Lac、Glu与S100β含量、MMSE评分比较,差异均无统计学意义(P>0.05),术后两组血清Lac、Glu与S100β含量、MMSE评分比较,实验组优于对照组,差异有统计学意义(P<0.05)。结论:远程缺血预处理后处理能减轻体外循环心脏手术患者脑损伤的程度,提高认知功能,具有较好的脑保护作用。

Objective. To explore the effects of remote ischemic preconditioning （RIPC） on cere- bral injury in cardiac operation with cardiopulmonary bypass. Methods. A total of 66 patients scheduled for open heart surgery under extracorporeal circulation were randomly divided into remote ischemic precondi- tioning （experimental group, n= 34 cases） and non-remote ischemic preconditioning group （control group, n=32 cases）. Propofol were used for total intravenous anesthesia in the two groups. Lactate（Lac）con- tent, glutamic acid （Glu） content and S100-13 protein （S10013）content in venous were measured before and 24h after undergoing the surgery. The cognitive function of the two groups was evaluated with the scale of Mini Mental State Examination （MMSE） at before and 72h after undergoing the surgery. Results. Before undergoing the operation, level of Lac, Glu, S1003and MMSE scores was not significant different between the two groups （P〈0.05）, but significant difference in these indicators were observed after undergoing the surgery, specifically, the experiment group showed better outcomes than the control group （P〈 0.05）. Conclusions： Remote ischemic preconditioning can alleviate the extent of brain injury of the patients in cardiac operation with cardiopulmonary bypass, it also improve cognitive function, protect the brain.