不同时相远隔缺血预处理对颈动脉内膜剥脱术患者术后认知功能及脑损伤的影响  

Effects of different phase remote ischemic preconditioning on postoperative cognitive function and brain injury in patients with carotid endarterectomy

作　　者：袁海军[1] 黄晓霞[1] 蓝志坚[1] 傅理[1] 彭文勇[1] YUAN Hai-jun;HUANG Xiao-xia;LAN Zhi-jian;FU Li;PENG Wen-yong(Department of Anesthesiology,Jinhua Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院麻醉科,浙江金华321000

出　　处：《中华全科医学》2022年第8期1328-1331,1335,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2020KY345);2021年度公益类金华市科学技术研究计划项目(2021-4-006)。

摘　　要：目的探讨颈动脉内膜剥脱术(CEA)采用不同时相远隔缺血预处理(RIPC)对患者术后认知功能、脑损伤的影响。方法选取2020年6月—2021年7月金华市中心医院收治的60例颈动脉重度狭窄患者,择期行颈动脉内膜剥脱术,按随机数字表法分为A组(术前1 h行RIPC方案)和B组(术前24 h行RIPC方案),每组30例,比较2组患者神经、认知功能,血清中枢神经特异性蛋白(S100-β)、脑源性神经营养因子(BDNF)、炎症因子、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)及并发症情况。结果2组患者MMSE评分各时间点间、组间、组和时间的交互作用差异均有统计学意义(F=3.302、4.321、8.717,均P<0.05);术后1个月,B组患者MMSE评分[(28.54±1.44)分]明显优于A组[(27.35±1.31)分,P<0.05]。术后24 h B组患者BDNF水平[(4.92±0.51)ng/mL]高于A组[(3.56±0.13)ng/mL,P<0.05]。术后24 h,2组患者IL-6、hs-CRP水平较术前1 d有所提高(均P<0.05);2组患者SBP、DBP、MAP、HR各时间点间、组间、组别和时间的交互作用差异均有统计学意义(均P<0.05)。A组认知功能降低发生率为16.67%,高于B组的10.00%,差异无统计学意义(P>0.05)。结论术前24 h实施RIPC能有效缓解CEA后脑损伤情况,提升患者神经、认知功能。Objective To investigate the effects of different phases of remote ischemic preconditioning(RIPC)on cognitive function and brain injury after carotid endarterectomy(CEA).Methods Sixty patients with severe carotid stenosis treated in Jinhua Central Hospital from June 2020 to July 2021 were randomly divided into group A(RIPC scheme 1 h before operation)and group B(RIPC scheme 24 h before operation),with 30 patients in each group.The neurological and cognitive functions and serum central nerve specific protein(S100)of the two groups were compared,including brain-derived neurotrophic factor(BDNF),inflammatory factors,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(map),heart rate(HR)and complications.Results Significant differences were noted in the interaction between the two groups at each time point,between groups and between groups and time(F=3.302,4.321,8.717,all P<0.05).One month after operation,the MMSE score of group B[(28.54±1.44)points]was significantly better than that of group A[(27.35±1.31)points,P<0.05].The level of BDNF in group B[(4.92±0.51)ng/mL]was higher than that in group A[(3.56±0.13)ng/mL,P<0.05].At 24 h after operation,the levels of IL-6 and hsCRP in the two groups were higher than those at 1 day before operation(all P<0.05).Significant differences were found in the interaction of SBP,DBP,map and HR between groups,groups and time between the two groups(all P<0.05).The incidence of cognitive impairment was 16.67%in group A and 10.00%in group B.The difference between the two groups was not significant(P>0.05).Conclusion The implementation of RIPC 24 h before operation can effectively alleviate brain injury after CEA and improve the neurocognitive function of patients.

关 键 词：颈动脉内膜剥脱术 远隔缺血预处理 认知功能 不同时相 神经功能 血清 并发症 

分 类 号：R743[医药卫生—神经病学与精神病学]