CAJ | 학술논문

目的评价葛根素预防体外循环(CPB)心脏直视术患者脑损伤的效果.方法择期全麻下心脏瓣膜置换术患者30例,性别不限,年龄50 ～ 64岁,体重50 ～ 75 kg,ASA分级Ⅲ级,采用随机数字表法将其分成2组(n=15):对照组(C组)和葛根素组(P组).P组于切皮即刻经30 min静脉输注葛根素400 mg,C组给予等容量5％葡萄糖氯化钠注射液.于麻醉诱导前(T0)、CPB 30 min(T1)、主动脉开放即刻(L)和CPB后6 h(T3)、12 h(T4)、24 h(T5)时取颈内静脉球部血样,测定血浆神经元特异性烯醇化酶(NSE)和S-100β蛋白浓度.于术前1 d及术后7d测定脑事件相关电位P300潜伏期和振幅,记录简易精神状态检查量表(MMSE)评分,术后MMSE评分低于术前2分以上或评分≤24分为术后认知功能障碍的诊断标准.结果与 C组比较,P组T1-5时血浆NSE和S-100β蛋白浓度降低,术后7d时P300潜伏期缩短,振幅升高,术后认知功能障发生率降低(P＜0.05) 结论葛根素可预防CPB心脏直视术患者脑损伤.
목적 평개갈근소예방체외순배(CPB)심장직시술환자뇌손상적효과.방법 택기전마하심장판막치환술환자30례,성별불한,년령50 ～ 64세,체중50 ～ 75 kg,ASA분급Ⅲ급,채용수궤수자표법장기분성2조(n=15):대조조(C조)화갈근소조(P조).P조우절피즉각경30 min정맥수주갈근소400 mg,C조급여등용량5％포도당록화납주사액.우마취유도전(T0)、CPB 30 min(T1)、주동맥개방즉각(L)화CPB후6 h(T3)、12 h(T4)、24 h(T5)시취경내정맥구부혈양,측정혈장신경원특이성희순화매(NSE)화S-100β단백농도.우술전1 d급술후7d측정뇌사건상관전위P300잠복기화진폭,기록간역정신상태검사량표(MMSE)평분,술후MMSE평분저우술전2분이상혹평분≤24분위술후인지공능장애적진단표준.결과 여 C조비교,P조T1-5시혈장NSE화S-100β단백농도강저,술후7d시P300잠복기축단,진폭승고,술후인지공능장발생솔강저(P＜0.05) 결론 갈근소가예방CPB심장직시술환자뇌손상.
Objective To evaluate the efficacy of puerarin for prevention of brain injury in the patients undergoing open heart surgery under cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅲ patients of both sexes,aged 50-64 yr,weighing 50-75 kg,scheduled for elective cardiac valve replacement under general anesthesia,were randomly divided into 2 groups (n =15 each) using a random number table:control group(group C) and puerarin group (group P).Puerarin 400 mg was infused intravenously over 30 min immediately at skin incision in group P and the equal volume of 5％ glucose-sodium chloride injection was given in group C.Before induction of anesthesia (T0),at 30 min of CPB (T1),immediately after aortic unclamping (T2),and at 6,12 and 24 h after termination of CPB (T3.5),blood samples were collected from the jugular venous bulb for determination of the plasma concentration of neuron-specific enolase (NSE) and S-100 β protein.P300 eventrelated potential latency and amplitude were determined and cognitive function was assessed by Mini-Mental State Examination (MMSE) score at 1 day before surgery and 7 days after surgery.The patients were diagnosed as having post-operative cognitive dysfunction when MMSE score before surgery-MMSE score after surgery ≥ 2,or when M MSE score≤ 24.Results Compared with group C,the concentrations of plasma NSE and S-100 β protein were significantly decreased at T15,and P300 event-related potential latency was shortened,P300 event-related potential amplitude was increased,and the incidence of postoperative cognitive dysfunction was decreased at 7 days after operation in group P.Conclusion Puerarin can prevent the brain injury in the patients undergoing open heart surgery under CPB.