颈动脉内膜剥脱术不同时间预处理对患者术后应激反应及神经功能的影响

Effects of different time preconditioning on postoperative stress response and neurological function of patients undergoing carotid endarterectomy

目的对比颈动脉内膜剥脱术(CEA)不同时间预处理对患者术后应激反应及神经功能的影响。方法回顾性收集2019年12月—2022年12月在我院择期行CEA术治疗的74例颈动脉狭窄(CS)患者临床资料,按远隔缺血预处理(RIPC)时间不同分成2组,其中A组37例(术前1 h进行预处理)、B组37例(术前24 h进行预处理)。对比2组术前1 d、麻醉诱导后、切皮时交感神经反应指标[收缩压(SBP)、心率(HR)、舒张压(DBP)]变化及手术前后简易精神状态评价量表(MMSE)评分、应激指标[去甲肾上腺素(NE)、白细胞介素-6(IL-6)、皮质醇(Cor)]、神经功能指标[脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S-100β)]水平。结果与A组相比,麻醉诱导后B组SBP、HR、DBP水平更高,切皮时SBP、HR、DBP水平更低(P<0.05);与A组相比,B组术后7 d、30 d MMSE评分更高(P<0.05);术后12 h、24 h 2组血清NE、Cor、IL-6水平均较术前1 d升高(P<0.05),但2组比较差异无统计学意义(P>0.05);与A组相比,B组术后12 h、24 h血清S-100β、NSE水平更低,血清BDNF水平更高(P<0.05)。结论CEA术前实施RIPC可减轻脑损伤,发挥脑保护作用,但与术前1 h实施RIPC相比,于术前24 h实施RIPC更有助于维持机体血流动力学稳定,促进认知功能及预后恢复。

Objective To compare the effects of different time preconditioning of carotid endarterectomy(CEA)on postoperative stress response and neurological function.Methods From December 2019 to December 2022,74 patients with carotid stenosis(CS)who were selected for CEA treatment in our hospital were retrospectively collected and divided into two groups according to the time of remote ischemic preconditioning(RIPC),including 37 cases in group A(preconditioning at 1 hour before surgery)and 37 cases in group B(preconditioning at 24 hours before surgery).The changes of sympathetic response indexes[systolic blood pressure(SBP),heart rate(HR),diastolic blood pressure(DBP)]in the 2 groups at 1 d before surgery,after the anesthesia induction,and at the time of skin incision before and after surgery,and the scores of the Mini-Mental State Examination(MMSE),stress indexes[norepinephrine(NE),interleukin-6(IL-6),cortisol(Cor)],and neurological function indexes[brain-derived neurotrophic factor(BDNF),neuron specific enolase(NSE),central nervous specific protein(S-100β)].Results Compared with group A,the levels of SBP,HR and DBP in group B after anesthesia induction were higher,and the levels of SBP,HR and DBP were lower during skin resection(P<0.05).Compared with group A,group B had higher MMSE scores at 7 and 30 days after surgery(P<0.05).The serum levels of NE,Cor and IL-6 in the 2 groups were increased 12 h and 24 h after surgery compared with 1 day before surgery(P<0.05),but there was no significant difference between the 2 groups(P>0.05).Compared with group A,serum S-100βand NSE levels in group B were lower at 12 h and 24 h after surgery,and serum BDNF level was higher in group B(P<0.05).Conclusions The administration of RIPC before CEA can reduce brain injury and play a protective role in brain.However,compared with the administration of RIPC 1 h before surgery,the administration of RIPC 24 h before surgery is more conducive to maintaining hemodynamic stability,promoting cognitive function and prognostic recovery.