参⻨注射液对⼼脏⼿术患者体外循环后认知功能的影响:⼀项随机对照试验
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Effect of Shenmai injection on cognitive function after
cardiopulmonary bypass in cardiac surgical patients: a
randomized controlled tria
背景与目的
认知功能障碍(POCD)是⼼脏⼿术后常⻅的并发症，会影响患者的临床疗效和⽣活质量。本研究旨在探讨参⻨注射液(SMI)对接受⼼脏瓣膜置换术的患者体外循环后POCD的影响。
方 法
这项前瞻性随机对照试验于2014年9⽉⾄2017年1⽉间进⾏。将要在CPB下接受⼼脏瓣膜置换术的88例患者随机分为对照组(C)和SMI (S)两组。从麻醉诱导到CPB开始期间静脉注射SMI (0.6 mL/kg)。在术前3天、术后3天、7天和1个⽉使⽤蒙特利尔认知评估(MoCA-BJ)量表对认知功能进⾏评估。在诱导后30分钟(T0),以及在⿐内的温度恢复到36 C时(T1),CPB之后的1 h(T2)、6 h(T3)、24⼩时(T4),48 h(T5),和72 h(T6)测定⾎清中神经珠蛋⽩(Ngb)低氧诱导因⼦-1α(HIF-1α)和特异性神经元烯醇酶⽔平(NSE)。
结 果
与T0时的基线值相⽐，C组⾎清Ngb⽔平在T1-2时显著降低，T3-6时升⾼，⽽S组与C组相⽐,⾎清Ngb⽔平在T1-2时降低，T4-6时升⾼(p < 0.05)。⾎清HIF-1α⽔平 在T1-4以及⾎清NSE⽔平在T1-6时，两组均有显著增加(p < 0.05)。相⽐于C组，S组⾎清Ngb在T3,HIF-1α在T1-3时,以及⾎清NSE在T3， 4、6组较低,(p < 0.01)。两组术后3、7天MoCA-BJ评分均下降，S组术后3、7天MoCA-BJ评分⾼于C组(p < 0.01)。
结 论
在CPB下进⾏⼼脏瓣膜置换术的患者术后认知功能受损。此外,使⽤传统中药SMI治疗可降低⾎清中Ngb,HIF-1α,以及⾎清NSE⽔平，减轻认知功能障碍。
原始文献摘要
Lei Chen , Liangrong Wang , Qian Zhuo；Effect of Shenmai injection on cognitive function after cardiopulmonary bypass in cardiac surgical patients: a randomized controlled trial；Chen et al. BMC Anesthesiology (2018) 18:142
Background: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass(CPB).
Methods: This prospective, randomized, controlled trial was conducted from September 2014 to January 2017. Eightyeight patients receiving cardiac valve replacement under CPB were randomized into the control (C) or the SMI (S) group. SMI (0.6 mL/kg) was administered intravenously from the time of anesthesia induction to the beginning of CPB. Cognitive function was assessed at 3 days before surgery and 3 days, 7 days, and 1 month after surgery using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) score. The serum levels of neuroglobin (Ngb),hypoxiainducible factor-1α (HIF-1α), and neuron-specific enolase (NSE) were measured at 30 min after induction (T0), immediately after the endonasal temperature rewarmed to 36 C (T1), and 1 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after CPB.
Results: Compared with the baseline values at T0, the serum Ngb levels in group C were significantly decreased at T1, 2 and then increased at T3 ,6, while the levels in group S were decreased at T1 ,2 and increased at T4 6, compared to group C (p <0.05). The serum HIF-1α levels at T1 ,4 and the serum NSE levels at T1 ,6
were significantly increased in both groups (p < 0.05). The serum levels of Ngb at T3, HIF-1α at T1 ,3, and NSE at T3 ,4,6 were lower in group S, compared to group C (p < 0.01). The MoCA-BJ scores were decreased at 3 and 7 days after surgery in both groups, and the MoCA-BJ scores in group S were higher than those in group C at 3 and 7 days after surgery (p < 0.01).
Conclusion: Cognitive function is impaired postoperatively in patients who
have undergone cardiac valve replacement under CPB. In addition, treatment with the traditional Chinese medicine SMI decreases the serum levels of Ngb, HIF-1α, and NSE as well as attenuates cognitive dysfunction.
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