高压氧预适应对心脏瓣膜置换术后的脑保护作用  

Cerebral protective effects of hyperbaric oxygen preconditioning on patients undergoing cardiac valve replacement

作　　者：吴帆[1] 周凯 高峰[1] 张近宝[1] 付西[3] 郭鑫[4] 何春阳[3] 

机构地区：[1]成都军区总医院心血管外科,成都610083 [2]东莞康华医院心脏外科 [3]成都军区总医院高压氧科,成都610083 [4]成都军区总医院中心实验室,成都610083

出　　处：《中国体外循环杂志》2015年第2期90-93,共4页Chinese Journal of Extracorporeal Circulation

基　　金：成都军区总医院院管课题面上项目(2013YG-B114)

摘　　要：目的观察术前高压氧(HBO)预适应对体外循环(CPB)下心脏瓣膜置换术后的脑保护作用。方法按入院先后顺序随机将42例拟行二尖瓣或主动脉瓣置换术患者分为对照组(n=20)和预适应组(n=22),预适应组在术前给予3次HBO预适应处理,比较两组患者在手术前后神经认知功能测试评分以及S100β蛋白和神经元特异性烯醇化酶(NSE)血清浓度的变化。结果 (1)两组患者围手术期临床资料比较无统计学差异(P>0.05)。(2)两组患者的神经认知功能评分在术前48 h时无统计学差异(P>0.05);两组患者术后1周神经认知功能评分除连线测试分数上升外,其余评分较术前均呈下降趋势,且手术前后评分大多无统计学差异(P>0.05),仅有数字符号测试分数在术后1周明显下降(P<0.05);对照组和预适应组术后1周分别有8例(40.0%)、2例(9.1%)发生术后认知功能障碍(POCD)(P<0.05)。(3)两组患者的S100β蛋白和NSE血清浓度从CPB后30 min开始上升,在停机1 h时达到峰值,然后逐渐下降,但直到停机24 h时仍高于术前水平(P<0.05)。预适应组的S100β蛋白浓度在停机1 h、12 h以及NSE浓度在停机1 h、12 h和24 h均明显低于对照组水平(P<0.05)。结论术前HBO预适应对心脏瓣膜置换术后患者能起到较好的脑保护作用。Objective To observe the cerebralprotective effects of preoperative hyperbaric oxygen（HBO） preconditioning onpatients after cardiac valve replacement by means of cardiopulmonary bypass（CPB）.Methods Forty-two cases who were going to re-ceive mitral or aortic valve replacement were randomized into control group（n = 20） and preconditioning group（n = 12）.Three ses-sions of HBO preconditioning were given to preconditioning group before operation. A comparative study was made to the changes ofneurocognitive testing, as well as serum concentration of protein S100β and neuron-specific enolase（NSE） between both groups perio-peratively.Results（1） The clinical data during perioperation between both groups showed no statistical difference（P〉0.05）.（2）There existed no statistical difference among neurocognitive test scores between both groups 48 h before operation（P〉0.05）. The scores of neurocognitive test except Trail Making Test in both groups all declined 1 week after operation. No statistical difference existedbetween preoperative and postoperative scores（P〉0.05） while Digit Symbol Test scores went down sharply 1 week after operation（P〈0.05）. Besides, 8 cases（40.0%） underwent post operative cognitive dysfunction（POCD） in control group compared to precondi-tioning group where 2 cases（9.1%） suffered from POCD（P〈0.05）.（3） The serum concentration of protein S100β and NSE in-creased from 30 min after CPB, peaked at 1 h after the end of CPB, and declined gradually, but the level were higher than that of pre-operation at 24 h after the end of CPB（P〈0.05）. The concentration of protein S100β at 1, 12 h after the end of CPB and NSE at 1,12, 24 h in preconditioning group were lower than that of control group（P〈0.05）.Conclusion Hyperbaric oxygen preconditioningbefore operation acted as a protector of brain for patients undergoing cardiac valve replacement surgery.

关 键 词：高压氧 预适应 心脏 瓣膜置换术 脑保护 

分 类 号：R654.2[医药卫生—外科学]