参麦注射液对体外循环心脏瓣膜置换术患者术后认知功能的影响  

Effect of Shenmai injection on postoperative cognitive function in patients undergoing cardiac valve replace- ment with cardiopulmonary bypass

作　　者：陈磊[1] 陈菲菲[1] 王晓燕[1] 王良荣[1] 汪炜健[1] 吴辉[1] 李丽玲[1] 缪剑霞[1] 林丽娜[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《中华麻醉学杂志》2013年第2期185-187,共3页Chinese Journal of Anesthesiology

基　　金：温州市科技局科研基金（H20100010）

摘　　要：目的参麦注射液对体外循环心脏瓣膜置换术患者术后认知功能的影响。方法择期CPB下心脏瓣膜置换术患者40例，年龄40～70岁，体重指数18-28kg／m2，ASA分级Ⅱ或Ⅲ级，NYHA分级Ⅱ或Ⅲ级，蒙特利尔认知评估（MoCA）评分≥26分。采用随机数字表法，将患者分为2组（n=20）：对照组（C组）和参麦注射液组（s组）。麻醉诱导后S组静脉输注参麦注射液0．6ml／kg（加入250ml生理盐水），C组给予等容量生理盐水，于转机前输注完毕。记录主动脉阻断时间、CPB时间、麻醉时间、麻醉药用量。于术前3d、术后3、7、14d进行MoCA评分（〈26分为发生POCD），记录术后14d内POCD的发生情况。结果2组患者主动脉阻断时间、CPB时间、麻醉时间、麻醉药用量比较差异无统计学意义（P〉0．05）；与术前3d比较，c组术后3、7d、S组术后3d时MoCA评分降低（P〈0．01）；与c组比较，s组术后3、7d时MoCA评分升高，POCD发生率降低（P〈0．05或0．01）。结论参麦注射液可改善CPB下心脏瓣膜置换术患者术后认知功能。Objective To investigate the effect of Shenmai injection （SMI） on postoperative cognitive function in patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）. Methods Forty ASA Ⅱ or Ⅲ patients （NYHA Ⅱ or Ⅲ）, with body mass index of 18-28 kg/m2 , with the Montreal Cognitive As- sessment （MoCA） scores≥ 26, undergoing cardiac valve replacement with CPB, were randomly divided into con- trol group （group C） and SMI group （group S）. After induction of anesthesia, SMI 0.6 ml/kg （in 250 ml of nor- mal saline） was infused intravenously in group S, while the equival volume of normal saline was given in group C, and the infusion was completed before CPB. Aortic clamping time, CPB time, duration of anesthesia and consump- tion of anesthetics were recorded. MoCA scores were assessed on day 3 before surgery and at days 3 and 7 and 14 d after surgery. The patients were diagnosed as having postoperative cognitive dysfunction （POCD） when MoCA scores 〈 26. POCD was recorded within 14 d after surgery. Results There was no significant difference in the aortic clamping time, CPB time, duration of anesthesia and consumption of anesthetics between the two groups （ P 〉 0.05）. MoCA scores were lower on days 3 and 7 after surgery in group C and on day 3 after surgery in group S than those on day 3 before surgery （P 〈 0.01）. Compared with group C, MoCA scores were increased on days 3 and 7 after surgery and the incidence of POCD was decreased in group S （ P 〈 0.05 or 0.01 ）. Conclusion SMI can improve the postoperative cognitive function in patients undergoing cardiac valve replacement with CPB.

关 键 词：中草药 心肺转流术 认知障碍 手术后并发症 

分 类 号：R65[医药卫生—外科学]