CAJ | 학술논문

目的：观察围手术期口服辛伐他汀（simvastatin）对成人体外循环（CPB）心脏瓣膜置换术患者血浆炎症因子、神经损伤标记物及认知、执行功能的影响。方法择期行心脏瓣膜置换术患者51例，随机分为辛伐他汀组（S组）和对照组（C组）。S组于围手术期口服辛伐他汀片20 mg/晚（术前口服＞5 d，术后第2天开始口服）；C组口服安慰剂。分别于术前、术后6 h、12 h、24 h、48 h、72 h抽取中心静脉血，测定术前、术后6～72 h血浆神经元特异性烯醇化酶（NSE）及S100β浓度，术前、术后6～24 h血浆炎症因子（TNFα、IL-6、IL-8）浓度；分别于术前1天、术后第5天使用简易智能状态检测法和蒙特利尔认知评估量表对患者进行认知评估，使用 Mattis 痴呆评定量表的主动与持续部分进行执行功能评估，并同时运用汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者情绪状态。结果两组患者在基线数据，术前、术后患者发病率与死亡率无明显差别。S组术后6 h、12 h血浆NSE、S100β浓度及术后6 h、12 h、24 h血浆IL-6浓度低于C组（P＜0.05）；S组术后认知、执行功能评估得分高于C组（P＜0.05），S组术后3例（12.5%）发生认知功能障碍（POCD），C 组术后7例（29.17%）发生 POCD，差异有统计学意义（P＜0.05）。结论在体外循环心脏瓣膜置换术患者中，围手术期口服辛伐他汀可减少体外循环后血浆炎症因子的浓度，降低POCD发生，改善患者执行功能。
목적：관찰위수술기구복신벌타정（simvastatin）대성인체외순배（CPB）심장판막치환술환자혈장염증인자、신경손상표기물급인지、집행공능적영향。방법택기행심장판막치환술환자51례，수궤분위신벌타정조（S조）화대조조（C조）。S조우위수술기구복신벌타정편20 mg/만（술전구복＞5 d，술후제2천개시구복）；C조구복안위제。분별우술전、술후6 h、12 h、24 h、48 h、72 h추취중심정맥혈，측정술전、술후6～72 h혈장신경원특이성희순화매（NSE）급S100β농도，술전、술후6～24 h혈장염증인자（TNFα、IL-6、IL-8）농도；분별우술전1천、술후제5천사용간역지능상태검측법화몽특리이인지평고량표대환자진행인지평고，사용 Mattis 치태평정량표적주동여지속부분진행집행공능평고，병동시운용한밀이돈초필량표화한밀이돈억욱량표평고환자정서상태。결과량조환자재기선수거，술전、술후환자발병솔여사망솔무명현차별。S조술후6 h、12 h혈장NSE、S100β농도급술후6 h、12 h、24 h혈장IL-6농도저우C조（P＜0.05）；S조술후인지、집행공능평고득분고우C조（P＜0.05），S조술후3례（12.5%）발생인지공능장애（POCD），C 조술후7례（29.17%）발생 POCD，차이유통계학의의（P＜0.05）。결론재체외순배심장판막치환술환자중，위수술기구복신벌타정가감소체외순배후혈장염증인자적농도，강저POCD발생，개선환자집행공능。
Objective Investigating perioperative statin treatment on systemic inflammatory response (SIR), postoperative neurological damage markers, cognition state and executive functioning in patients receiving cardiac valve replacement surgery with cardiopulmonary bypass(CPB). Methods 51 patients who underwent valvular surgery with CPB were enrolled and were randomly divided into two groups. Group S (n=26): the patients taken simvastatin 20 mg qn in the perioperative period. Group C (n=25): the control group received a placebo. Plasma levels of pro-inflammatory interleukins (tumour necrosis factor-alpha (TNF-α), interleukin (IL-6, IL-8) were measured before and 6 h, 12 h, 24 h after surgery, and plasma levels of NSE and S100β were measured before and 6 h, 12 h, 24 h,48 h, 72 h after surgery. Mini-mental state examination (MMSE) and Montreal Cognitive Assessment(MoCA) were used to evaluate cognition state, and Initiation-Perseveration subtest of the Mattis Dementia Rating Scale(MDRS-IP) was applied to evaluate executive function. While Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to valuate emotional state. Ever patient was evaluated at 1 d before and 5 d after operation. Results The baseline, operative and postoperative morbidity and mortality characteristics were similar for both the groups. Group S had lower postoperative levels of IL-6 at 6 h ,12 h, 24 h (P<0.05). The postoperative NSE and S100βlevels at 6 h and at 12 h were lower in the group S(P<0.05). Group S get higher scores in the Cognition state and executive function tests (P<0.05). The incidence of postoperative cognition disorders(POCD) in group S (3 patients, 12.5%) was lower than that in group C (7 patients, 29.17%) (P<0.05). Conclusion Perioperative treatment with statins is associated with a lower biochemical parameters of SIR and incidence of POCD and better performance of executive functioning following cardiac valve replacement surgery with CPB.