参麦注射液对体外循环下心脏瓣膜置换术患者术后认知功能的影响  

Effect of Shenmai injection on changes of patients' cognitive function after received cardiopulmonary bypass

作　　者：缪剑霞[1] 陈磊[1] 陈菲菲[1] 林丽娜[1] 

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325015

出　　处：《温州医学院学报》2014年第5期338-341,共4页Journal of Wenzhou Medical College

基　　金：温州市科技局科研基金资助项目(H20100010)

摘　　要：目的：观察参麦注射液（SMI）对体外循环（CPB）下心脏瓣膜置换术后患者认知功能的影响。方法：择期CPB下心脏瓣膜置换术患者40例，术前ASA分级和NYHA分级均为Ⅱ～Ⅲ级，简明精神状态量表（MMSE）评分≥26分。患者随机分为SMI组（S组，n=20）及对照组（C组，n=20）。麻醉诱导后转机前，S组静脉滴注SMI（0.6mL/kg加至250mL0.9%氯化钠溶液中），C组滴注等量0.9%氯化钠溶液。记录患者主动脉阻断、CPB及麻醉维持时间，观察麻醉诱导前（T0）、诱导后10min（T1）、复温至36℃（T2）、CPB停机1h（T3）、6h（T4）、24h（T5）、48h（T6）、72h（T7）时血流动力学及血气分析结果，术后3d复测MMSE并评估认知功能。结果：两组患者主动脉阻断时间、CPB时间、麻醉维持时间及血流动力学差异无统计学意义（P＞0.05）；与T0比较，C组T1～T2、T4～T7时、S组T1、T4～T7时血氧饱和度（SJvO2）、血氧分压（PJvO2）下降（P＜0.05或P＜0.01）；与C组比较，S组T2～T3时SJvO2、PJvO2升高（P＜0.01）；术后3d，S组MMSE评分高于C组（P＜0.01），术后认知功能障碍（POCD）的发生率明显降低（P＜0.01）。结论：CPB下心脏瓣膜置换术可导致患者认知功能发生障碍，而SMI可通过提高脑组织的氧供应，从而改善患者的认知功能。Objective： To observe the changes of patient’s cognitive function after undergoing cardiac valve replacement with cardiopulmonary bypass （CPB） and the intervention effect of Shenmai injection （SMI）.Meth-ods： Forty United States Association of Anesthesiologists （ASA） II or III patients （New York Heart Association, NYHA II or III） of the Mini-Mental State Examination （MMSE, range 0~30） scores≥26 after undergoing cardi-ac valve replacement with CPB were randomly divided into SMI group （group S,n=20） and control group （group C,n=20）. After anesthesia induction, the patients of group S were infused intravenously with SMI （0.6 mL/kg added to 250 mL normal saline）, and the patients of group C were given with equivalent normal saline at the same time, both completed before CPB. Aortic clamped time, CPB time, duration of anesthesia were recorded. Heart rate （HR）, mean arterial pressure （MAP）, jugular venous oxygen saturation （SJvO2） and jugular venous oxygen partial pressure （PJvO2） of anesthesia induction （T0）, 10 min after induction （T1）, CPB re-warmed to 36℃（T2）, and 1 h （T3）, 6 h （T4） , 24 h （T5）, 48 h （T6）, 72 h （T7） after CPB were recorded. MMSE were performed three days after surgery and the incidence of POCD was recorded.Results： There was no statistical signiifcance in aortic clamped time, duration of CPB, anesthesia time, and hemodynamics （P〉0.05） between the two of groups. Com-pared with T0, SJvO2 and PJvO2 of group C from T1 to T2, T4 to T7 and group S at T1, T4 to T7 decreased （P〈0.05, P〈0.01）. Compared with group C, SJvO2 and PJvO2 of group S at T2 and T3 increased （P〈0.01）. MMSE evalua-tion and the incidence of POCD of group S were better than those of group C three days after surgery （P〈0.05, P〈0.01）.Conclusion： Cardiac valve replacement with CPB can lead to cognitive impairment in patients and Shenmai injection can improve cognitive function by increasing oxygen supply for brain tissue

关 键 词：心肺转流术 认知障碍 参麦注射液 

分 类 号：R654.1[医药卫生—外科学] R749.1[医药卫生—临床医学]