高压氧联合远程缺血预适应对 心脏术后的脑保护作用研究

Protective effect of combined preconditioning with hyperbaric oxygen and remote ischemia on brain after cardiac valve replacement surgeries

摘要:

目的 探讨高压氧联合远程缺血预处理对心脏瓣膜置换术后患者神经认知功能、炎症因子水 平及患者恢复状况的影响。方法 选取2013 年1 月-2015 年12 月于成都军区总医院心血管外科行心脏瓣 膜置换术的72 例患者，根据治疗方案的不同将患者分为高压氧组（HBO 组）和高压氧+ 远程缺血预处理 （RIPC）组（HBO+RIPC 组），比较两组患者术后神经认知功能、炎症因子水平及恢复情况。结果 两组患 者围手术期临床资料比较，差异无统计学意义（P >0.05）。两组患者围手术期相关指标比较，差异无统计学意 义（P >0.05）。HBO+RIPC 组患者术后血清NSE 水平和S100B 水平低于HBO 组（P <0.05），两组患者术后 2 和7 d 的MMSE 评分及POCD 发生率比较，差异无统计学意义（P >0.05）。两组患者IL-6 水平比较，差异 无统计学意义（P >0.05），两组患者TNF-α 水平比较，差异有统计学意义（P <0.05）。两组患者低心排综合征、 肾功能不全、ICU 时间、术后住院时间及呼吸支持时间比较，差异无统计学意义（P >0.05）。结论 与HBO 组相比，HBO+RIPC 组对心脏瓣膜置换术后患者认知功能和恢复情况无明显改善作用。

Abstract:

Objective To evaluate the impacts of hyperbaric oxygen (HBO) combined with remote ischemic preconditioning (RIPC) on cognitive function, levels of inflammatory factors and recovery of the patients after cardiac valve replacement surgeries. Methods Seventy-two patients undergoing cardiac valve replacement surgeries were prospectively enrolled in the Department of Cardiovascular Surgery in Chengdu Military General Hospital from January 2013 to December 2015, and divided into a sole HBO treatment group and a HBO+RIPC group according to their treatment regimens (36 in each group). The cognitive function, levels of inflammatory factors and recovery of the patients after operation were compared. Results There were no statistical differences in the perioperative clinical characteristics or related indexes in the patients of the two groups (P > 0.05). The HBO+RIPC group had significantly decreased cerebral injury markers of plasma S100B and NSE than the HBO group after surgery. However, there was no significant difference in MMSE score or incidence of postoperative cognitive dysfunction between the two groups 2 and 7 d after surgery (P > 0.05). Plasma inflammatory marker IL-6 showed no significant change between the two groups (P > 0.05), while TNF-α was significantly decreased in response to the additional treatment with RIPC (P < 0.05). There was no significant difference in low cardiac output syndrome, renal dysfunction, ICU stay, postoperative hospital stay or mechanic ventilation time between the two groups (P > 0.05). Conclusions In comparison with the sole HBO preconditioning group, the HBO+RIPC regimen has no significant improvement on cognitive function or recovery of the patients after cardiac valve replacement.