术前注射甲泼尼龙琥珀酸钠对心脏外科手术患者术后谵妄及认知功能障碍的影响

Impact of preoperative methylprednisolone on postoperative delirium and cognitive dysfunction in patients undergoing cardiac surgery

目的:评价术前静脉注射甲泼尼龙琥珀酸钠对体外循环下心脏外科手术患者术后谵妄及POCD的影响。方法:选取安阳地区医院2017年1月至2018年1月于体外循环下行心脏外科手术的患者,年龄18~65岁,ASA分级Ⅱ~Ⅲ级。患者随机分为甲泼尼龙琥珀酸钠组(methylprednisolone group,M组)和安慰剂组(Placebo group,P组),M组46例,P组45例。M组患者分别于麻醉诱导前、体外循环前静脉注射甲泼尼龙琥珀酸钠250 mg;P组患者静脉注射等量安慰剂。于术前1 d(T0)、术后1 d(T1)、术后3 d(T3)、术后7 d(T7)、术后30 d(T30)评估患者MMSE评分。于T0,T1,T3时点抽取外周静脉血检测S100β蛋白、神经元特异性烯醇化酶(NSE),IL-6,IL-1β,IL-8浓度。结果:M组患者T1,T3时点IL-6,IL-1β,IL-8水平显著低于P组患者,差异有统计学意义(P<0.05)。M组患者T1,T3时点S100β,NSE水平显著低于P组患者,差异有统计学意义(P<0.05)。两组患者术后各时点MMSE评分差异无统计学意义(P>0.05)。两组均未见术后谵妄的发生。两组患者POCD发生率差异均无统计学意义(P>0.05)。结论:术前静注甲泼尼龙琥珀酸钠能够有效抑制体外循环下心脏手术患者术后炎症反应,但在术后谵妄及术后认知功能障碍方面并未体现出明显优势。

Objective:To investigate the effects of methylprednisolone on postoperative delirium and cognitive dysfunction(POCD)in patients undergoing cardiac surgery.Methods:A total of 91 patients aged 18–65 years with ASA grade Ⅱ-Ⅲ were enrolled in our hospital from January 2017 to January 2018 undergoing cardiac surgery.Patients were randomly divided into two groups according to random sequence number generated by SPSS 19.0:methylprednisolone group(group M,n=46)and placebo group(group P,n=45).The patients in M group were injected methylprednisolone 250mg intravenously before induction of anesthesia and cardiopulmonary bypass.The patients in P group were injected the same amount of 0.9%sodium chloride injection.mini-mental state examination(MMSE)were evaluated before anesthesia(T0),1 day(T1),3 day(T3),7 day(T7)and 30 day(T30)after operation.The levels of S100β,neuron-specific enolase(NSE),IL-1β,IL-6,IL-8 were tested at T0,T1 and T3.Results:The levels of IL-6,IL-1β,IL-8,S100βand NSE in M group were lower than those in P group at T1 and T3(P<0.05).The number of CD3+,CD4+,CD8+,CD4+/CD8+,natural killer cell in EA group were higher than those in GA group at T2 and T3(P<0.05).The levels of cortisol,C-reactive protein in EA group were lower than those in GA group at T2 and T3(P<0.05).There was no significant difference between the two groups in MMSE score at T1,T3,T7 and T30(P>0.05).Postoperative delirium was not observed in either group.There was no significant difference in the incidences of POCD between the two groups(P>0.05).Conclusion:Intraoperative methylprednisolone can effectively inhibit postoperative inflammatory response in patients undergoing on-pump cardiac surgery,but it can't decrease the incidences of postoperative delirium and POCD.