舒芬太尼预处理对冠脉旁路移植术围术期认知功能和心肌保护的作用

Influence of sufentanil preconditioning on early cognitive function and myocardial protection in patients undergoing on-pump CABG

目的:观察术前舒芬太尼延迟性预处理对体外循环下冠状动脉旁路移植术(CABG)围术期认知功能和心肌的保护作用。方法:选择择期在体外循环下行CABG的患者60例,随机均分为舒芬太尼预处理组(舒芬太尼组)和常规治疗对照组(对照组),分别在术前、主动脉开放1h、6h、12h、24h、48h采集血标本,测定心肌肌钙蛋白I(cTnI)水平,并在术前,术后7d接受神经心理(POCD)评价。结果:舒芬太尼组血清cTnI水平在主动脉开放后1h到术后48h均明显低于对照组[1h:(14.96±2.13)ng/ml比(23.66±3.15)ng/ml],P均<0.05;两组在进入ICU后12h、24h、48h的正性肌力药物使用得分舒芬太尼组明显低于对照组[12h:(6.4±0.6)分比(8.4±0.6)分],P均<0.05;舒芬太尼组术后认知功能障碍(POCD)发生率明显低于对照组(13.3%比30.0%,P=0.041)。结论:舒芬太尼的延迟预处理对体外循环下冠状动脉旁路移植术患者有心肌保护效应,同时可降低认知功能障碍的发生率,具有一定的脑保护作用。

Objective： To observe influence of preoperative sufentanil delayed preconditioning （SPC） on perioperative cogni- tive function and myocardial protection effect in patients undergoing on - pump coronary artery bypass grafting （OP- CABG）. Methods： A total of 60 patients undergoing selective OPCABG were randomly and equally divided into sufentanil group （SPC group） and routine treatment control group （control group）, blood sample was collected before operation, lh, 6h, 12h, 24h and 48h after aorta declamping to measure level of cardiac troponin I （cTnT） ; and all patients received neu- ropsychological assessment before and 7d after operation. Results： Compared with control group, there was significant re- ductions in serum cTnI levels [lh： （23.66 ± 3. 15） ng/ml vs. （14. 96 ± 2. 13） ng/ml] in sufentanil group from lh after aor- ta declamping to 48h after CABG, P〈0. 05 all. The inotropic agent usage score on 12h, 24h and 48h after entering ICU of sufentanil group was significantly lower than that of control group [12h： （6. 4 ± 0. 6） scores vs. （8. 4 ± 0. 6） scores], P〈 0. 05 all. Incidence rate of postoperative cognitive dysfunction （POCD） in sufentanil group was significantly lower than that of control group （13. 3% vs. 30.0%, P = 0. 041）. Conclusion： Preoperative sufentanil delayed preconditioning posses- ses myocardial protection effect, and reduce incidence rate of cognitive dysfunction so also possesses certain brain protection in patients undergoing on- pump coronary artery bypass grafting.