远端预处理对体外循环下心脏瓣膜置换术患者脑损伤的保护作用

翁立军; 张野; 胡宪文; 李云

doi:10.13898/j.cnki.issn.1000-2200.2016.01.007

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

远端预处理对体外循环下心脏瓣膜置换术患者脑损伤的保护作用

翁立军 , 张野 , 胡宪文 , 李云

文章导航 > 蚌埠医学院学报 > 2016, 41 > 1: (28-31)

引用本文:

Citation:

远端预处理对体外循环下心脏瓣膜置换术患者脑损伤的保护作用

安徽医科大学第二附属医院麻醉科, 安徽合肥 230601

作者简介: 翁立军(1982-),男,博士研究生.

基金项目:
安徽医科大学科研基金项目(2012xkj056)

安徽省教育厅省级自然科学研究项目(KJ2013Z117)
中图分类号: R614.24

The protective effect of remote ischemic preconditioning on the brain injury of patients treated with cardiac valve replacement under cardiopulmonary bypass

Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei Anhui 230601, China
CLC number: R614.24

摘要: 目的:探讨远端预处理(remote ischemic preconditioning,RIPC)对体外循环(cardiopulmonary bypass,CPB)下瓣膜置换手术中脑损伤的保护作用。方法:将体外循环心脏瓣膜置换术患者40例随机分为远端预处理组(RIPC组)和对照组,各20例。麻醉诱导后CPB前,以骨科充气式压力止血带环扎左上臂上施压(压力200 mmHg),循环3次,每次5 min,间隔5 min;对照组处理同RIPC组,但止血带不充气。分别于麻醉诱导稳定5 min后(T₀)和手术结束即刻(T₁)、术后1 h(T₂)、6 h(T₃)和24 h(T₄)5个时间点抽取颈内静脉球部血检测S-100β、神经元特异性烯醇化酶(NSE)。对于所有接受手术的患者分别在术前1 d和术后第3、8天行神经心理测验和评估。结果:2组患者S-100β和NSE蛋白水平在T₁~T₄均显著高于T₀(P<0.01),但RIPC组S-100β在T₁~T₃和NSE水平在T₁~T₄时均明显低于对照组(P<0.01)。RIPC组术后3 d简易智能量表和蒙特利尔认知评估量表评分均低于对照组(P<0.05和P<0.01)。结论:RIPC可降低CPB下心脏瓣膜置换术患者血清NSE、S-100β蛋白水平,降低患者术后认知功能障碍发生率,具有脑保护作用。
- 体外循环 /
- 远端预处理 /
- 脑保护 /
- S-100β蛋白 /
- 神经元特异性烯醇化酶
Abstract: Objective:To investigate the protective effects of remote ischemic preconditioning(RIPC) on the brain injury of patients treated with cardiac valve replacement under cardiopulmonary bypass(CPB).Methods:Forty patients treated with cardiac valve replacement under CPB were randomly divided into the RIPC group and control group(CON group)(20 cases each group).After induction of anesthesia and before cardiopulmonary bypass, the pressure of left upper arm in RIPC group was increased by cerclage with orthopedic inflatable pressure tourniquet, loop 3 times, 5 min each time, and an interval of 5 min.The treatment of the CON group was the same as the RIPC group, but the tourniquet was not inflated.The levels of S-100β protein and NSE in internal carotid artery bulb were detected after 5 min of the induction of anaesthesia stability(T₀), at the end of operation(T₁), and at postoperative 1 h(T₂), 6 h(T₃) and 24 h(T₄).The neuropsychology in all operation patients were tested and assessed before 1 day of operation and after 3 and 8 days of operation.Results:The levels of S-100β and NSE in two groups at T₂ to T₄ were significantly higher than those at T₀(P<0.01), but the levels of S-100β at T₂ and T₃, and the levels of NSE at T₂ to T₄ in RIPC group were significantly lower than those in CON group(P<0.01).The MMSE and MoCA scores in RIPC group after 3 days of operation were lower than those in CON group(P<0.05 to P<0.01).Conclusions:The RIPC can decrease the levels of S-100β and NSE in the patients treated with cardiac valve replacement under CPB, and the incidence of cognitive impairment of patients, which can play a role on protecting brain.
- cardiopulmonary bypass /
- remote ischemic preconditioning /
- brain protection /
- S-100β /
- neuronal specific enolase

[1]	JENSEN HA,LOUKOGEORGAKIS S,YANNOPOULOS F,et al. Remote ischemic preconditioning protects the brain against injury after hypothermic circulatory arrest[J]. Circulation, 2011, 123(7):714.
[2]	PRZYKLENK K,BAUER B,OVIZE M,et al. Regional ischemic preconditioning protects remote virgin myocardium from subsequent sustained coronary occlusion[J]. Circulation,1993,87(3):893.
[3]	ZHOU W,ZENG D,CHEN R,et al. Limb ischemic preconditioning reduces heart and lung injury after an open heart operation in infants[J]. Pediatr Cardiol,2010,31(1):22.
[4]	VENUGOPAL V,LAING CM,LUDMAN A,et al. Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery:a secondary analysis of 2 small randomized trials[J]. Am J Kidney Dis,2010,56(6):1043.
[5]	HOGUE CW JR,PALIN CA,ARROWSMITH JE. Cardiopulmonary bypass management and neurologic outcomes:an evidence-based appraisal of current practices[J]. Anesth Analg,2006,103(1):21.
[6]	BASILE AM,FUSI C,CONTI AA,et al. S-100 protein and neuron-specific enolase as markers of subclinical cerebral damage after cardiac surgery:preliminary observation of a 6-month follow-up study[J]. Eur Neurol,2001,45(3):151.
[7]	KUZUMI E,VUYLSTEKE A,GUO X,et al. Serum S100 protein as a marker of cerebral damage during cardiac surgery[J]. Br J Anaesth,2000,85(6):936.
[8]	姚明. 剑桥老年认知量表在帕金森病认知测评中的应用[J]. 安徽医科大学学报,2009,44(1):88.

[1]	黄家琴 , 杨杰 . 血清前白蛋白和神经元特异性烯醇化酶检测在新生儿缺氧缺血性脑病诊断中的临床意义. 蚌埠医学院学报, 2019, 44(2): 219-221. doi: 10.13898/j.cnki.issn.1000-2200.2019.02.024
[2]	李明 , 马士恒 , 李芳 , 苏维 . 丙种球蛋白治疗重症手足口病临床效果及其对血清S-100β蛋白、NSE的影响研究. 蚌埠医学院学报, 2017, 42(8): 1045-1047. doi: 10.13898/j.cnki.issn.1000-2200.2017.08.010
[3]	杨百武 , 张庆 , 杜京承 , 王昆 , 李丹 , 赵开雷 . 右美托咪定对颅内血肿清除术患者S100β蛋白和神经元特异性烯醇化酶的影响. 蚌埠医学院学报, 2016, 41(8): 1038-1041. doi: 10.13898/j.cnki.issn.1000-2200.2016.08.019
[4]	俞万丛 , 苟大明 . 体外循环肺损伤与保护的研究进展. 蚌埠医学院学报, 2012, 36(12): 1554-1558.
[5]	武开宏 , 刘学刚 . 体外循环对肺脏的损伤及肺保护的研究进展. 蚌埠医学院学报, 2007, 32(2): 246-247.
[6]	谢军 , 张侠 , 李红林 . 不同血液标本及存放时间对神经元特异性烯醇化酶测定的影响. 蚌埠医学院学报, 2013, 37(12): 1654-1655.
[7]	朱成 , 王淮 . 神经元特异性烯醇化酶检测对颅脑损伤诊断分型及判断预后的临床意义. 蚌埠医学院学报, 2014, 38(1): 50-52.
[8]	姜磊 , 刘弋 . NSE和S-100在先天性巨结肠及其同源病诊断中的应用. 蚌埠医学院学报, 2012, 36(5): 525-528.
[9]	马明祥 , 郭华静 , 潘道波 , 刘红波 . 右美托咪定用于体外循环心脏手术的临床观察. 蚌埠医学院学报, 2017, 42(4): 469-471. doi: 10.13898/j.cnki.issn.1000-2200.2017.04.015
[10]	俞万丛 , 芶大明 , 蔡回钧 . 氯沙坦对犬体外循环肺损伤的影响. 蚌埠医学院学报, 2014, 39(9): 1159-1162,1167.
[11]	黄慧 . 有创动脉血压监测在体外循环术后应用的护理. 蚌埠医学院学报, 2009, 34(3): 257-258.
[12]	樊小倩 , 孙晴 , 仲怀凤 , 陈晴晴 , 陆真 . 体外循环心脏术后并发压力性损伤预测模型的建立. 蚌埠医学院学报, 2022, 47(12): 1752-1755. doi: 10.13898/j.cnki.issn.1000-2200.2022.12.030
[13]	王龙 , 张勇 . 右美托咪定对新生儿肠闭锁术后苏醒质量及血清NSE、S100β蛋白水平的影响. 蚌埠医学院学报, 2020, 45(1): 35-39, 43. doi: 10.13898/j.cnki.issn.1000-2200.2020.01.009
[14]	程咏 , 常芸 , 陈娟 , 王秋静 , 张金美 . 闭式体外循环下微创二尖瓣手术21例护理体会. 蚌埠医学院学报, 2013, 37(12): 1713-1714.
[15]	杨军 , 台晓燕 . 血清NSE、S100B和IL-6在早产儿脑损伤的临床应用. 蚌埠医学院学报, 2019, 44(10): 1362-1364, 1369. doi: 10.13898/j.cnki.issn.1000-2200.2019.10.019
[16]	张从利 , 任丽 , 梅玫 , 刘娣 , 施超 , 李晓红 . 右美托咪定对体外循环冠状动脉旁路移植术病人炎性反应和急性肾损伤的影响. 蚌埠医学院学报, 2020, 45(4): 464-468. doi: 10.13898/j.cnki.issn.1000-2200.2020.04.011
[17]	方炜 , 胡英超 , 王雪芹 , 陈莉莉 , 张峰 . 低月龄、低体质量体外循环患儿乳酸水平与血糖及氧合指标的相关性. 蚌埠医学院学报, 2021, 46(9): 1197-1200. doi: 10.13898/j.cnki.issn.1000-2200.2021.09.011
[18]	闵祥振 , 高国豪 , 郭蕊 , 王南海 . 脑氧饱和度监测技术指导术中干预措施在降低心脏术后认知功能障碍发生率的应用. 蚌埠医学院学报, 2019, 44(11): 1461-1464. doi: 10.13898/j.cnki.issn.1000-2200.2019.11.007
[19]	许华斌 . 血清肿瘤标志物联合检测在肺癌诊断中的应用. 蚌埠医学院学报, 2014, 39(8): 1113-1116.
[20]	刘彬 , 汪国胜 , 钟平 , 年夫顺 , 张尊胜 . 偏头痛患者MRI亚临床病变的特点. 蚌埠医学院学报, 2015, 40(11): 1500-1502. doi: 10.13898/j.cnki.issn.1000-2200.2015.11.012

点击查看大图

计量

文章访问数: 2522
HTML全文浏览量: 366
PDF下载量: 120
被引次数: 0

远端预处理对体外循环下心脏瓣膜置换术患者脑损伤的保护作用

作者简介: 翁立军(1982-),男,博士研究生.

安徽医科大学第二附属医院麻醉科, 安徽合肥 230601

收稿日期: 2014-10-31

基金项目: 安徽医科大学科研基金项目(2012xkj056)安徽省教育厅省级自然科学研究项目(KJ2013Z117)

关键词:

摘要: 目的:探讨远端预处理(remote ischemic preconditioning,RIPC)对体外循环(cardiopulmonary bypass,CPB)下瓣膜置换手术中脑损伤的保护作用。方法:将体外循环心脏瓣膜置换术患者40例随机分为远端预处理组(RIPC组)和对照组,各20例。麻醉诱导后CPB前,以骨科充气式压力止血带环扎左上臂上施压(压力200 mmHg),循环3次,每次5 min,间隔5 min;对照组处理同RIPC组,但止血带不充气。分别于麻醉诱导稳定5 min后(T₀)和手术结束即刻(T₁)、术后1 h(T₂)、6 h(T₃)和24 h(T₄)5个时间点抽取颈内静脉球部血检测S-100β、神经元特异性烯醇化酶(NSE)。对于所有接受手术的患者分别在术前1 d和术后第3、8天行神经心理测验和评估。结果:2组患者S-100β和NSE蛋白水平在T₁~T₄均显著高于T₀(P<0.01),但RIPC组S-100β在T₁~T₃和NSE水平在T₁~T₄时均明显低于对照组(P<0.01)。RIPC组术后3 d简易智能量表和蒙特利尔认知评估量表评分均低于对照组(P<0.05和P<0.01)。结论:RIPC可降低CPB下心脏瓣膜置换术患者血清NSE、S-100β蛋白水平,降低患者术后认知功能障碍发生率,具有脑保护作用。

English Abstract

The protective effect of remote ischemic preconditioning on the brain injury of patients treated with cardiac valve replacement under cardiopulmonary bypass

Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei Anhui 230601, China

Received Date: 2014-10-31

Abstract: Objective:To investigate the protective effects of remote ischemic preconditioning(RIPC) on the brain injury of patients treated with cardiac valve replacement under cardiopulmonary bypass(CPB).Methods:Forty patients treated with cardiac valve replacement under CPB were randomly divided into the RIPC group and control group(CON group)(20 cases each group).After induction of anesthesia and before cardiopulmonary bypass, the pressure of left upper arm in RIPC group was increased by cerclage with orthopedic inflatable pressure tourniquet, loop 3 times, 5 min each time, and an interval of 5 min.The treatment of the CON group was the same as the RIPC group, but the tourniquet was not inflated.The levels of S-100β protein and NSE in internal carotid artery bulb were detected after 5 min of the induction of anaesthesia stability(T₀), at the end of operation(T₁), and at postoperative 1 h(T₂), 6 h(T₃) and 24 h(T₄).The neuropsychology in all operation patients were tested and assessed before 1 day of operation and after 3 and 8 days of operation.Results:The levels of S-100β and NSE in two groups at T₂ to T₄ were significantly higher than those at T₀(P<0.01), but the levels of S-100β at T₂ and T₃, and the levels of NSE at T₂ to T₄ in RIPC group were significantly lower than those in CON group(P<0.01).The MMSE and MoCA scores in RIPC group after 3 days of operation were lower than those in CON group(P<0.05 to P<0.01).Conclusions:The RIPC can decrease the levels of S-100β and NSE in the patients treated with cardiac valve replacement under CPB, and the incidence of cognitive impairment of patients, which can play a role on protecting brain.