远隔缺血预处理对轻度认知功能障碍患者非体外循环冠脉搭桥术后认知功能的影响

Effect of remote ischemic preconditioning on cognitive function in patients with mild cognitive impairment after off-pump coronary artery bypass graft surgery

目的评价远隔缺血预处理(RIPC)对轻度认知功能障碍(MCI)患者非体外循环冠脉搭桥手术(OPCABG)后认知功能的影响。方法择期行OPCABG患者60例,年龄范围为65~80岁,美国麻醉医师协会(ASA)分级II或III级,术前经蒙特利尔量表(MoCA)、简易智力状态量表(MMSE)、痴呆量表(CDR)和日常生活能力量表(ADL)被判定为MCI。采用随机数字表法,将患者分为两组:对照组(C组,n=30)和RIPC组(R组,n=30)。R组于麻醉诱导后5min于患者右上肢上臂采用测压袖带给予3个循环的5min缺血(袖带充气,压力≥200mmHg)及5min再灌注(袖带放气至0mmHg)处理;C组将袖带绑于患者右上肢,但不进行充气及放气操作。分别于术前1d(T0)、术后7d(T1)及30d(T2)时采用MoCA和MMSE评估患者认知功能。结果与T0时比较,T1时两组MMSE和MoCA评分均降低[(25.2±0.7)分比(21.4±0.6)分、(25.5±0.8)分比(22.3±0.7)分、(21.8±0.7)分比(18.2±0.7)分、(22.0±1.0)分比(19.4±0.8)分,P<0.05];与T1时比较,T2时两组MMSE和MoCA评分均升高[(21.4±0.6)分比(22.8±0.9)分、(22.3±0.7)分比(23.6±0.8)分、(18.2±0.7)分比(19.5±0.8)分、(19.4±0.8)分比(20.7±0.9)分,P<0.05];T1~T2时R组MMSE和MoCA评分均高于C组(P<0.05)。结论RIPC对改善MCI患者OPCABG术后30d内的认知功能具有一定的积极作用。

Objective To evaluate the effect of remote ischemic preconditioning (RIPC) on cognitive function in patients with mild cognitive impairment (MCI) after off-pump coronary artery bypass grafting (OPCABG). Methods Sixty patients with OPCABG were enrolled, aged 65-80 years old, American Society of Anesthesiologists (ASA) grade II or III, judged as MCI by preoperative Montreal Scale (MoCA), Simple Intelligence Status Scale (MMSE), Dementia Scale (CDR), and the Daily Living Ability Scale (ADL). The patients were divided into 2 groups by random number table method: control group (group C, n=30) and RIPC group (group R, n=30). In group R, 5 minutes after induction of anesthesia, a manometry cuff was used to give 3 cycles of 5 min ischemia (cuff inflation, pressure ≥200 mmHg) and 5 min reperfusion (cuff deflation to 0 mmHg) treatment;in group C, the cuff was tied to the patients' right upper limb, but did not inflate and deflate. The cognitive function was evaluated by MoCA and MMSE at 1 day before surgery (T0), 7 days (T1) and 30 days (T2) after surgery. Results Compared with T0, MMSE and MoCA scores were decreased at T1 in both two groups [(25.2±0.7) vs.(21.4±0.6),(25.5±0.8) vs.(22.3±0.7),(21.8±0.7) vs.(18.2±0.7),(22.0±1.0) vs.(19.4±0.8), all P<0.05]. Compared with T1, MMSE and MoCA scores of both two groups were increased at T2 [(21.4±0.6) vs.(22.8±0.9),(22.3±0.7) vs.(23.6±0.8),(18.2±0.7) vs.(19.5±0.8),(19.4±0.8) vs.(20.7±0.9), all P<0.05]. MMSE and MoCA scores in group R were higher than those in C group from T1 to T2 (all P<0.05). Conclusion RIPC can improve cognitive function within 30 days after OPCABG in MCI patients.