血浆硫化氢水平与体外循环心脏瓣膜置换术患者术后认知功能障碍的关系研究

Relationship between Plasma Hydrogen Sulfide Level and Postoperative Cognitive Dysfunction in Patients Undergoing Heart Valve Replacement with Cardiac Pulmonary Bypass

目的分析血浆硫化氢(H2S)水平与体外循环(CPB)心脏瓣膜置换术患者术后认知功能障碍(POCD)的关系。方法选取2016年7—12月于武警广东省总队医院心外科行择期CPB心脏瓣膜置换术患者60例,根据术后72 h内POCD发生情况分为POCD组22例与非POCD组38例。比较两组患者麻醉诱导前(T_0)、CPB结束时(T_1)、术毕(T_2)、术后24 h(T_3)、术后72 h(T_4)血清S100β蛋白、神经元特异性烯醇化酶(NSE)水平及血浆H2S水平,并分析血浆H_2S水平与血清S100β蛋白、NSE水平的相关性。结果本组60例患者POCD发生率为36.7%(22/60)。两组患者性别、年龄、受教育年限、CPB时间、手术时间、出血量、拔管时间、清醒时间比较,差异无统计学意义(P>0.05)。时间与方法在血清S100β蛋白、NSE水平和血浆H_2S水平上存在交互作用(P<0.05);时间在血清S100β蛋白、NSE水平和血浆H_2S水平上主效应显著(P<0.05);方法在血清S100β蛋白、NSE水平和血浆H_2S水平上主效应显著(P<0.05);T_1~T_4时POCD组患者血清S100β蛋白、NSE水平高于非POCD组,血浆H_2S水平低于非POCD组(P<0.05)。Pearson相关性分析结果显示,POCD组患者血浆H_2S水平与血清S100β蛋白、NSE水平呈负相关(r值分别为-0.91、-0.82,P<0.05)。结论血浆H_2S水平与CPB心脏瓣膜置换术患者POCD有关,可作为POCD的监测指标。

Objective To analyze the relationship between plasma hydrogen sulfide （ H2S） level and postoperative cognitive dysfunction in patients undergoing heart valve replacement with cardiac pulmonary bypass （CPB）. Methods From July to December in 2016, a total of 60 patients undergoing elective heart valve replacement with CPB were selected in the Department of Cardial Surgery＇, Guangdong Provincial General Hospital of Armed Police, and they were divided into A group （complicated with postoperative cognitive dysfunction, n=22） and B group （did not complicate with postoperative cognitive dysfunction, n = 38） according to the inciderice of postoperative cognitive dysfunction. Serum levels of SI0013 protein and NSE, and plasma H2S level before anesthesia induction （T0）, immediately after CPB （T1）, immediately after heart valve replacement （ T2 ）, after 24 hours of heart valve replacement （ T3 ） and after 72 hours of heart valve replacement （ T4 ） were compared between the two groups, meanwhile correlations between plasma H2S level and serum level of S100β protein, of NSE were analyzed. Results The incidence of postoperative cognitive dysfunction was 36. 7% （22/60）. No statistically significant differences of gender, age, years for education, duration of CPB, duration of heart valve replacement, blood loss, extubation time and awake time was found between the two groups （ P 〉 0. 05 ）. There was interaction between time and method in serumlevels of S100β protein and NSE, and plasma H2S level （P 〈 0. 05） ; the main effects of time anti method were significant in serum levels of S100β protein and NSE, and plasma H2S level （P 〈0. 05） ; from T1 to T4, serum levels of S100β protein and NSE of A group were statistically significantly higher than those of B group, while plasma H2S level of A group was statistically slgnificantly lower than that of B group, respectively （P 〈0. 05）. Pearson correlation analysis resuhs showed that, plasma I-t,.S level was negatively correlated with serum levels of SIOOI3 protein and NSE, respectively （ r = - 0. 91 , - 0. 82 ; P 〈 0. 05 ）. Conclusion Plasma H2S level is associated with postoperative cognitive dysfunction in patients undergoing tleart valve replacement with CPB, may be served as monitoring indicator of postoperative cognitive dysfunction.