小儿先心病术后认知功能障碍评价方法初探

目的 探讨复方麝香对小儿先心病体外循环术后认知功能障碍（POCD）的影响。方法 择期行体外循环（CPB）辅助下6～14岁小儿先心病矫治术50例（ASAⅡ～Ⅲ级），随机分为复方麝香注射液组（A组，1 mL/kg），生理盐水对照组（B组，1 mL/kg）。分别于两组麻醉苏醒期停用静吸全麻药后开始静脉泵注复方麝香注射液和生理盐水。分别评测患儿术前第1天和术后第4天的简易精神量表（MMSE）的评分，以及术前10 min，术后第1天，术后第4天监测患儿血浆白细胞介素2（IL-2）、雌二醇（E2）、泌乳素（PRL）水平; 结果 A组术后的MMSE评分均高于B组（P>0.05），术后第1天B组患儿为21分，巳达轻度认知障碍；A组术后对应时间点的IL-2值均低于B组（P<0.05），且PRL及E2值明显高于B组（P<0.05）； 结论 先心病体外循环术后，于关胸缝合皮下组织时静注复方麝香注射液(1 mg/kg)对小儿早期认知功能障碍有一定的改善作用。 【关键词】 小儿 先心病 认知功能障碍 复方麝香注射液

The appropriate measurement of postoperative cognitive dysfunction after children CHD surgery

【Abstract】 Objective To evaluate the appropriate measurement of postoperative cognitive dysfunction after CHD surgery. Methods 50 patients aged 6-14 yr undergoing elective CHD surgeries with CPB were randomly divided into two groups: Group A, were injected with Fufangshexiang injection (1ml/kg). Group B, were injected with normal saline (NS) (1ml/kg).Both tow groups were injected in the period of at the end time of surgeries. The cognitive function in the two groups was tested with Mini Mental State Examination (MMSE) in 24 hours before and 96 hours after the operations. The interleukin 2(IL-2) and the serum sex hormone levels including estradiol 2 (E2) and prolactin (PRL) in the two groups were measured. The samples were recruited in different times: before, 24 hours after, and 96 hours after the operations individually. Results There were no difference of the scores of MMSE among the group A and B (P＞0.05). The levels of serum PRL and E2 of the group A were significantly higher than those in the group B (P＜0.05). The levels of IL-2 of group A were significantly lower than those in the group B (P＜0.05). Conclusions MMSE maybe not a measurement suitable for the POCD of CHD surgeries. The serum sex hormone and interleukins could become evaluating tools for the POCD of CHD surgeries.