醒脑静在体外循环心脏手术中对脑功能的保护

doi:10.6040/j.issn.1671-7554.0.2014.513

摘要/Abstract

摘要： 目的探讨醒脑静注射液在体外循环心脏手术中对患者脑功能的影响。方法选择心脏瓣膜手术患者30例,随机分为实验组和对照组,各15例。实验组在体外循环预充液中按0.33 mL/kg加入醒脑静注射液,对照组加入等量0.9%氯化钠溶液,分别于体外循环转机前(T₁)、主动脉阻断后30 min(T₂)、主动脉开放后30 min(T₃),主动脉开放后2 h(T₄)抽取患者颈静脉血和桡动脉血,检测神经元特异性烯醇化酶(NSE)、同型半胱氨酸(Hcy)浓度及血气指标,并根据血气指标计算上述时间点脑摄氧率(CEO₂)。术后采用ICU谵妄评估方法(CAM-ICU)评估术后患者谵妄的发生情况。结果在体外循环心脏手术中,实验组在T₂、T₃和T₄时间点NSE水平低于对照组(P<0.05)。实验组在T₃、T₄ 时间点Hcy水平低于对照组(P<0.05)。实验组在T₄时间点CEO₂高于对照组(P<0.05)。术后患者谵妄发生率实验组为6.7%,对照组为33.3%,差异具有统计学意义(P<0.05)。结论醒脑静注射液在体外循环心脏手术中可以有效调节NSE和Hcy,降低脑部损伤,促进脑功能及早恢复并能有效降低患者术后早期谵妄的发生。

关键词: 体外循环, 特异性烯醇化酶, 同型半胱氨酸, 摄氧率, 谵妄, 醒脑静注射液

Abstract: Objective To explore the effects and possible influence of Xingnaojing injection in cardiopulmonary bypass surgery with brain function. Methods Thirty valve replacement patients were randomly categorized into the experience group and the control group with 15 cases in each group. The experience group was treated with Xingnaojing injection(0.33 mL/kg) in the priming solution, while the control group were treated with 0.9% sodium chloride solution(0.33 mL/kg). To extract the patients' blood in the jugular venous and radial artery in turn before cardiopulmonary bypass(T₁), 30 mins after aortic cross-clamping (T₂), 30 mins after aortic opening(T₃), 2 hours after aortic opening(T₄) for the detection of neuron specific enolase(NSE), homocysteine (Hcy) and blood gas. At the same time, cerebral oxygen uptake rate(CEO₂) was calculated according to the blood gas in the above mentioned time points of extracorporeal circulation. The incidence of postoperative delirium was compared between the two groups with Confusion Assessment Method for Intensive Care Unit(CAM-ICU). Results In cardiac operation with extracorporeal circulation, the level of NSE in the experience group was significantly lower than that of the control group at the time points of T₂、T₃、T₄(P<0.05). The level of Hcy in the experience group was also significantly lower than that of the control group at the time points of T₃、T₄(P<0.05). The value of CEO₂ in the experience group were significantly higher than that of the control group at the time points of T₄(P<0.05). The incidence of postoperative delirium was significantly lower in the experience group(6.7%) compared with the control group(33.3%) (P<0.05). Conclusion Xingnaojing injectioncan effectively regulate NSE and Hcy in cardiopulmonary bypass heart operation. It can alleviate brain injury and promote the early recovery of brain function, thus, effectively reduce the incidence of early postoperative delirium in patients.

Key words: Cardiopulmonary bypass, Homocysteine, Delirium, Xingnaojing injection, Neuron-specific enolase, Cerebral oxygen uptake rate

中图分类号:

R654.1

韩潇, 刘锟, 史加海, 高福民, 尤庆生. 醒脑静在体外循环心脏手术中对脑功能的保护[J]. 山东大学学报（医学版）, 2015, 53(1): 54-57.

HAN Xiao, LIU Kun, SHI Jiahai, GAO Fumin, YOU Qingsheng. Cerebral protection of Xingnaojing injection in patients undergoing cardiopulmonary bypass surgery[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(1): 54-57.

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