银杏达莫注射液对体外循环心脏瓣膜置换术患者的脑保护作用  

Cerebral Protective Effects of Ginkgo Leaf Extract and Dipyridamole Injection on Patients Undergoing Cardiac Valve Replacement with Cardiopulmonary Bypass

作　　者：涂杰[1] 刘国锋[1] 梁蓓薇[1] 刘菊梅[1] 李涛[1] 韦秋英[1] 张炳东[1] 

机构地区：[1]广西医科大学第一附属医院心血管病研究所手术麻醉室,南宁市530021

出　　处：《广西医学》2014年第5期627-630,共4页Guangxi Medical Journal

基　　金：广西中医药民族医药科研课题(GZZC1230)

摘　　要：目的观察银杏达莫注射液对体外循环（CPB）心脏瓣膜置换术患者围术期血浆S-100β蛋白、神经元特异性烯醇化酶（NSE）和认知功能的影响,评估其脑保护作用。方法择期行体外循环下心脏瓣膜置换术患者60例,蒙特利尔认知评估（MoCA）≥26分,无认知功能障碍。采用随机数字表法将患者分为观察组和对照组,每组30例。麻醉诱导后观察组静脉输注银杏达莫注射液0.5 ml/kg,对照组输注等容量生理盐水,均于体外循环开始前输注完毕。分别于体外循环前（T0）,体外循环后30 min（T1）,体外循环停止时（T2）,手术结束时（T3）,术后24 h（T4）、48 h（T5）测定血浆S-100β蛋白和NSE浓度;分别于术前1 d和术后2 d用蒙特利尔认知评估（MoCA）量表评估患者的认知功能。结果与观察组T1~T4时点血浆S-100β蛋白和NSE浓度均明显低于对照组（P均〈0.05）;术后2 d观察组MoCA评分明显高于对照组（P〈0.05）,认知功能障碍发生率明显低于对照组（P〈0.05）。结论银杏达莫注射液可降低体外循环下心脏瓣膜置换术患者血浆S-100β蛋白和NSE浓度,降低患者术后认知功能障碍发生率,具有脑保护作用。Objective To observe the effects of ginkgo leaf extract and dipyridamole injection on plasma S-100βprotein,neuronal specific enolase （ NSE ） and cognitive function in patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）,and to assess the cerebral protective effects of ginkgo leaf extract and dipyridamole injection . Methods Sixty patients with Montreal cognitive assessment （MoCA） score≥26 and without cognitive dysfunction,undergoing cardiac valve replacement with CPB,were randomly divided into two groups （n=30 each）：observation group and control group. After induction of anesthesia,ginkgo leaf extract and dipyridamole injection （0.5 ml/kg） was infused intravenously in the observation group,while the equivalent volume of normal saline was given in the control group ,and the infusion was completed before CPB.Blood samples were taken from central vein before CPB （T0 ,baseline）,30 minutes of CPB （T1 ）,the end of CPB （T2）,the end of operation （T3）,and 24 （T4）,48 hours （T5） after operation for determination of concentrations of plasma S-100βprotein and NSE.MoCA was used to assess the patient′s cognitive function 1 day before operation and 2 days after operation.Results The concentrations of plasma S-100βprotein and NSE at T 1 ,T2 ,T3 ,T4 were significantly lower in the observation group than those in the control group （ all P〈0.05 ） .The MoCA score was significantly higher while the incidence of postoperative cognitive function was significantly lower 2 days after operation in the observation group than those in the control group （ P〈0.05 ） .Conclusion Ginkgo leaf extract and dipyridamole injection can reduce the concentrations of plasma S-100βprotein and NSE , and increase the incidence of postoperative cognitive function in patients undergoing cardiac valve replacement with CPB ,which has a cerebral protective effect .

关 键 词：心脏瓣膜疾病 银杏达莫注射液 体外循环 心脏瓣膜置换术 脑保护 

分 类 号：R542.5[医药卫生—心血管疾病]