围术期口服辛伐他汀对心脏瓣膜置换患者术后炎症因子与认知执行功能的影响  

Effects of perioperative statin treatment on inflammations reaction and postoperative cognition disorders in patients receiving cardiac valve replacement surgery

作　　者：陶俊[1] 华平[1] 杨淞然[2] 刘剑扬 杨艳旗[1] 

机构地区：[1]中山大学孙逸仙纪念医院心脏外科,广州510120 [2]广州市第一人民医院脑内科

出　　处：《中华临床医师杂志（电子版）》2013年第24期54-57,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广东省科技计划项目(2012B031800258);中山大学青年教师培育项目(11ykpy30)

摘　　要：目的：观察围手术期口服辛伐他汀（simvastatin）对成人体外循环（CPB）心脏瓣膜置换术患者血浆炎症因子、神经损伤标记物及认知、执行功能的影响。方法择期行心脏瓣膜置换术患者51例，随机分为辛伐他汀组（S组）和对照组（C组）。S组于围手术期口服辛伐他汀片20 mg/晚（术前口服＞5 d，术后第2天开始口服）；C组口服安慰剂。分别于术前、术后6 h、12 h、24 h、48 h、72 h抽取中心静脉血，测定术前、术后6～72 h血浆神经元特异性烯醇化酶（NSE）及S100β浓度，术前、术后6～24 h血浆炎症因子（TNFα、IL-6、IL-8）浓度；分别于术前1天、术后第5天使用简易智能状态检测法和蒙特利尔认知评估量表对患者进行认知评估，使用 Mattis 痴呆评定量表的主动与持续部分进行执行功能评估，并同时运用汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者情绪状态。结果两组患者在基线数据，术前、术后患者发病率与死亡率无明显差别。S组术后6 h、12 h血浆NSE、S100β浓度及术后6 h、12 h、24 h血浆IL-6浓度低于C组（P＜0.05）；S组术后认知、执行功能评估得分高于C组（P＜0.05），S组术后3例（12.5%）发生认知功能障碍（POCD），C 组术后7例（29.17%）发生 POCD，差异有统计学意义（P＜0.05）。结论在体外循环心脏瓣膜置换术患者中，围手术期口服辛伐他汀可减少体外循环后血浆炎症因子的浓度，降低POCD发生，改善患者执行功能。Objective Investigating perioperative statin treatment on systemic inflammatory response （SIR）, postoperative neurological damage markers, cognition state and executive functioning in patients receiving cardiac valve replacement surgery with eardiopulmonary bypass（CPB）. Methods 51 patients who underwent valvular surgery with CPB were enrolled and were randomly divided into two groups. Group S （n=26）： the patients taken simvastatin 20 mg qn in the perioperative period. Group C （n=25）： the control group received a placebo. Plasma levels of pro-inflammatory interleukins （tumour necrosis factor-alpha （TNF-a）, interleukin （IL-6, IL-8） were measured before and 6 h, 12 h, 24 h after surgery, and plasma levels of NSE and S10013 were measured before and 6 h, 12 h, 24 h,48 h, 72 h after surgery. Mini-mental state examination （MMSE） and Montreal Cognitive Assessment（MoCA） were used to evaluate cognition state, and Initiation-Perseveration subtest of the Mattis Dementia Rating Scale（MDRS-IP） was applied to evaluate executive function. While Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） were used to valuate emotional state. Ever patient was evaluated at 1 d before and 5 d after operation. Results The baseline, operative and postoperative morbidity and mortality characteristics were similar for both the groups. Group S had lower postoperative levels of IL-6 at 6 h ,12 h, 24 h （P〈0.05）. The postoperative NSE and S10013 levels at 6 h and at 12 h were lower in the group S（P〈0.05）.Group S get higher scores in the Cognition state and executive function tests （P〈0.05）. The incidence of postoperative cognition disorders（POCD） in group S （3 patients, 12.5%） was lower than that in group C （7patients, 29.17%） （P〈0.05）. Conclusion Perioperative treatment with statins is associated with a lower biochemical parameters of SIR and incidence of POCD and better performance of executive functioning following cardiac valve replacement surge

关 键 词：心脏瓣膜 人工 体外循环 认知障碍 辛伐他汀 炎症反应 

分 类 号：R654.2[医药卫生—外科学]