川芎嗪对老年患者体外循环心脏手术炎性反应及术后认知功能的影响

Effects of Ligustrazine on Inflammatory Reaction and Postoperative Cognitive Function in Elderly Patients Undergoing Open-heart Surgery

目的观察川芎嗪对老年患者体外循环(CPB)心脏手术炎性反应及术后认知功能的影响。方法选择2012年3月—2013年4月在宁波第一医院择期行单瓣膜(左房室瓣或主动脉瓣)置换术的风湿性心脏瓣膜病患者40例,采用随机双盲法将入选患者分为川芎嗪组(20例)和对照组(20例)。川芎嗪组于麻醉诱导前经颈内静脉滴注川芎嗪3 mg/kg,20 min内滴完,CPB预充液中也加入川芎嗪3 mg/kg;对照组给予等容量的0.9%氯化钠溶液。于CPB前(T1)、CPB结束时(T2)、CPB心脏手术后2 h(T3)、CPB心脏手术后24 h(T4)、CPB心脏手术后72 h(T5)5个时间点采集静脉血,测定血浆超敏C反应蛋白(hs-CRP)、白介素(IL)-6、IL-10的水平;采用简易精神状态量表(MMSE)评估患者CPB心脏手术前1 d(t1)、CPB心脏手术后1 d(t2)和CPB心脏手术后3 d(t3)的认知功能状态。结果两组患者hs-CRP、IL-6、IL-10在不同时间点比较,差异均有统计学意义(P<0.05);与T1比较,两组患者hs-CRP、IL-6、IL-10在T2、T3、T4、T5时间点均升高(P<0.05);两组比较,川芎嗪组患者hs-CRP、IL-6在T2、T3、T4、T5时间点低于对照组(P<0.05);川芎嗪组患者IL-10在T2、T3时间点高于对照组(P<0.05)。两组患者t2、t3时间点MMSE评分低于t1(P<0.05),且均出现了术后认知功能下降;两组比较,川芎嗪组患者t2、t3时间点MMSE评分高于对照组(P<0.05);川芎嗪组患者t2、t3时间点认知功能障碍(POCD)发生率(40%、35%)与对照组(25%、15%)比较,差异无统计学意义(P>0.05)。结论川芎嗪能降低老年患者CPB心脏手术后的炎性反应和认知功能障碍程度,促进其术后恢复,为临床应用提供了参考依据。

Objective To investigate the effects of ligustrazine on inflammatory reaction and postoperative cognitive function in elderly patients undergoing open - heart surgery. Methods 40 patients undergoing cardiac single valve replacement surgery with cardiopulmonary bypass （CPB） in the First Hospital of Ningbo form March 2012 to April 2013 were randomly divided into two groups. Group A （n = 20）： patients received ligustrazine 3 mg/kg before anesthesia induction by jugular vein injection was instilled within 20 minutes, and 3 mg/kg was added to the priming solution. Group B （n = 20）： the same dose of saline was used. The plasmatic hs - CRP, IL - 6, IL - 10 was determined before CPB （T1）, after CBP （T2）, 2 h after surgery （T3）, 24 h after surgery （T4） and 72 h after surgery （T5）. Cognitive function of .patients was evaluated by MMSE 1 d before operation （t1）, 1 d after operation （t2） and 3 d after operation （t3）. Results The plasmatic hs - CRP, IL - 6, IL - 10 of patients in two groups at each time point of T2 to T5 was significantly higher than that at Tl point （P 〈 0. 05 ）; compared with that of Group B, the plasmatic hs - CRP and IL - 6 of Group A at time point of T2 to T5 was lower （P 〈 0. 05） and the plasmatic IL - 10 at time point of T2 to T3 was higher （P 〈 0. 05）. The MMSE score of patients in two groups at each time point of t2 and t3 were significantly lower than that at tl point （P 〈 0. 05）, postoperative cognition of patients in two groups was impaired after surgery. Compared to that of patients in Group B, the MMSE score of patients in Group A at time point＇of t2 and t3 were higher （ P 〈 0. 05）. The incidence of POCD of patients in Group A at time point of t2 and t3 was 5 （ 25 %） and 3 （15 % ） respectively, and the incidence of POCD in Group B at time point of t2 and t3 was 8 （40%） and 7 （35%）, there was no significant difference （P 〉 0. 05 ）. Conclusion Ligustrazine can decrease the degree of the impairment of the postoperative cognition in elderly patients undergoing open - heart surgery and promote its improvement.