摘要
目的探究还原型谷胱甘肽(GSH)对全身麻醉下心肺转流(CPB)心脏手术患者脑损伤的保护作用。方法2020年1月至2022年12月之间在本院择期行CPB下心脏瓣膜手术的140例患者被随机分为观察组和对照组,每组70例。所有患者均采用相同的麻醉方案,观察组在麻醉诱导成功后颈内静脉注射GSH,对照组注射等量生理盐水。观察术后认知功能障碍发生率,比较术前、术后3 d、术后1周采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分;比较麻醉诱导后即刻(T0)、CPB开始后30 min(T1)、手术结束(T2)、术后6 h(T3)、术后24 h(T4)、术后72 h(T5)的脑损伤标志物和炎性因子。结果观察组术后认知障碍发生率为7.14%,显著低于对照组22.86%(P<0.05)。术前两组各指标差异无统计学意义(P>0.05);术后3 d观察组MMSE评分和MoCA评分显著高于对照组(P<0.05)。两组血清神经元特异性烯醇化酶(NSE)、S100β蛋白和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)在T1、T2、T3时刻持续升高,在T4时刻开始回落,T5时刻基本回落到T0水平;T1、T2、T3、T4时刻观察组血清NSE、S100β、TNF-α和IL-6均显著低于对照组(P<0.05),经组间·不同时间点间交互效应比较,差异具有统计学意义(P<0.05)。两组围术期脑电双频指数、平均动脉压、心率、麻醉剂用量、自动复跳率以及心率失常发生率差异均无统计学意义(P>0.05)。结论GSH可以显著减轻CPB心脏手术患者术后认知功能障碍发生率,减轻神经功能损伤,改善炎症反应。
Objective To explore the protective effect of reduced-glutathione(GSH)on brain injury in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB)by general anesthesia.Methods 140 patients who underwent elective heart valve surgery with CPB in our hospital from January 2020 to December 2022 were randomly divided into an observation group and a control group,with 70 cases in each group.All patients were treated with the same anesthesia regimen.After successful anesthesia induction,the observation group was injected with GSH via the internal jugular vein,while the control group was injected with an equal amount of physiological saline.The incidence of postoperative cognitive impairment and the Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)score before,3 days after,and 1 week after surgery were compared.The brain injury markers and inflammatory factors at immediately after anesthesia induction(T0),30 minutes after CPB initiation(T1),end of surgery(T2),6 hours after surgery(T3),24 hours after surgery(T4),and 72 hours after surgery(T5)were also compared.Results The incidence of postoperative cognitive impairment in the observation group was 7.14%,significantly lower than 22.86%in the control group(P<0.05).There was no statistically significant difference in various indicators between the two groups before surgery(P>0.05);The MMSE score and MoCA score in the observation group were significantly higher than those in the control group 3 days after surgery(P<0.05).Both groups’serum neuron specific enolase(NSE),S100β protein and tumor necrosis factor-α(tumor necrosis factor-α,TNF-α),interleukin-6(IL-6)were continuesly increased at T1,T2,and T3,decreased at T4,and generally returned to T0 levels at T5;Serum NSE,S100 and TNF-α,IL-6 in the observation group at T1,T2,T3,and T4 time points were significantly lower than those in the control group(P<0.05),and the differences were statistically significant(P<0.05)after comparing the interaction effects between groups at different time points.There was no statistically significant difference in perioperative BIS,MAP,HR,anesthetic dosage,automatic rebound rate,and incidence of heart rate arrhythmia between the two groups(P>0.05).Conclusions GSH can significantly reduce the incidence of postoperative cognitive impairment,alleviate neurological damage,and alleviate inflammatory response in patients undergoing cardiac surgery with CPB.
作者
闫立会
刘志飞
闫建敏
苗振华
Yan Lihui;Liu Zhifei;Yan Jianmin;Miao Zhenhua(Department of Anesthesiology,Xingtai Third Hospital,Hebei Xingtai,054000,China)
出处
《中国体外循环杂志》
2023年第6期336-341,共6页
Chinese Journal of Extracorporeal Circulation
基金
邢台市重点研发计划项目(2022ZC193)
关键词
还原型谷胱甘肽
心肺转流
心脏瓣膜手术
认知功能障碍
神经损伤标志物
脑保护
Reduced-glutathione
Cardiopulmonary bypass
Heart valve surgery
Cognitive dysfunction
Nerve injury markers
Cerebral protection
作者简介
通信作者:苗振华,Email:ylhui223@126.com
