参附注射液预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响

目的 观察参附注射液（SFI）预处理及后处理对体外循环心脏瓣膜置换术后患者认知功能的影响。

Effects of Preconditioning and Postconditioning with Shenfu Injection on Cognitive Function in Patients after Valve Replacement under Cardiopulmonary Bypass

Objective To investigate the effects of preconditioning and postconditioning with Shenfu Injection （SFI） on cognitive function in patients after valve replacement under extra-corporeal circulation. Methods Thirty-two patients prepared to receive valve replacement, aged 25-54 years, with heart function of Ⅱ-Ⅲ level, were randomly assigned to four groups, eight in each group. Patients in group E1 received SFI 1 mL/kg after intubation and before blocking the aorta; patients in group E2 received SFI 1 mL/kg after opening the aorta;patients in group E3received SFI 0.5 mL/kg twice, at before blocking and after opening the aorta, respectively; and patients in group C received 1 mL/kg normal saline after intubation for control. All the medication was infused via pump. Venous blood samples were taken from the internal jugular venous bulb cannula for detecting plasma S100β protein by ELISA at 6 different time points, i.e. after trachea intubation （T1）, 10 min after cardiopulmonary bypass （CPB, T2） , hypothermia stabilizing stage （T3） , re-warming to 33℃（3 （T4） , ending CPB （T6） and 1 h after ending CPB （T6）. And patients＇ cognitive function was assessed for 4 times with mini-mental state examination （MMSE） scale, at the day before operation, and 1, 2, 7 days after operation. Results The elevation of S100β plasma protein was lesser in the three E groups than that in group C （P〈0.05）, and the lowest level was shown at T8 in Group E3（P〈0.05）. The highest incidence of cognitive dysfunction occurred in Group C one week after operation （ P 〈 0. 05）. Conclusion SFI may reduce the plasma level of S100β protein, maintain stable the structure and function of blood-brain barrier, it is favorable to the post-operational recovery of neurological function of patients, showing good brain protective effect. The optimal effect could be obtained by pump infusion of 0.5 mL/kg of SFI before aortic blocking and after aortic opening.