乌司他丁对心脏联合瓣膜置换术患者S100β蛋白及早期认知功能障碍影响.docVIP

乌司他丁对心脏联合瓣膜置换术患者S100β蛋白及早期认知功能障碍的影响 　　[摘要] 目的 观察乌司他丁对心脏联合瓣膜置换术患者血浆S100β蛋白及术后早期认知功能的影响，探讨其对脑损伤的影响。 方法 择期于我院行心脏联合瓣膜置换术患者40例随机分为两组各20例。实验组于麻醉诱导后静脉泵入乌司他丁1.2万U/kg，体外循环（CPB）预充液中加入0.6万U/kg，主动脉开放前5 min CPB加入0.6万U/kg；对照组给予等容量生理盐水。在麻醉诱导给药前（T1）、CPB开始后30 min（T2）、CPB结束后30 min（T3）、CPB结束后3 h（T4）、CPB结束后6 h（T5）及术后24 h（T6）测定血浆S100β蛋白浓度。采用简易智能状态量表（MMSE），于术前1 d及术后第2、7天对患者进行评分。 结果 实验组中T2～T6血浆S100β蛋白浓度明显低于对照组（P0.05），实验组早期POCD发生率明显低于对照组，差异有统计学意义（P0.05）。 结论 乌司他丁的应用可以降低心脏联合瓣膜置换术后早期POCD发生率，具有脑保护作用。 　　[关键词] 心脏手术；S100β蛋白；乌司他丁；认知功能障碍 　　[中图分类号] R614.2 [文献标识码] B [文章编号] 1673-9701（2015）14-0074-04 　　[Abstract] Objective To observe the effects of ulinastatin on S100β protein and early post-operative cognitive function of the patients undergoing cardiac combined valve replacement surgery. To explore the effect of ulinastatin on brain injury. Methods A total of 40 patients who were undergoing cardiac combined valve replacement surgery electively in our hospital，were randomly divided into two groups， each of 20 cases. The patients of experimental group received ulinastatin 12000 U/kg after anesthesia induction by intravenously pumping， 6000 U/kg ulinastatin was added to the priming solution， and 6000 U/kg ulinastatin was given before 5 min of the aortic decamping.The patients of control group were given equal volume of physiological saline. Serum concentration of S100β protein were measured before administration of anesthesia induction（T1）， 30 min after CPB（T2）， 30min after the end of CPB（T3）， 3 h after the end of operation （T4）， 6 h after the end of operation （T5）， and 24 h after the end of operation （T6）. Patients were investigated by using mini mental state examination （MMSE） in 1 day before operation， 2 days after operation and 7 days after operation. Results Compared with control group， the concentration of S100β protein was lower in T2-T6 point of experimental group （P0.05）. The incidence of POCD experimental group was significantly lower than that of control group， with statistical differenc