远隔缺血时处理对体外循环瓣膜置换术患者脑损伤的影响

[目的]观察远隔缺血时处理对体外循环（CPB）瓣膜置换术患者血清S100-β蛋白和神经元特异性烯醇化酶（NSE）的影响及与术后神经精神功能障碍的关系。[方法]择期CPB下瓣膜置换术患者60例，随机分为3组（n＝20）：远隔缺血时处理组（A组）、远隔缺血预处理组（B组）和对照组（C组）。A组在CPB主动脉阻断后同时对右下肢予以3周期5min缺血/5min再灌注处理；B组在麻醉诱导后予以该处理。于术前（T1）、CPB结束即刻（T2）、CPB结束后5h（T3）、24h（T4）取右颈内静脉血，检测血清S100-β蛋白和NSE浓度；于术前1d、术后d3、d7对患者行神经系统检查并记录简易精神状态量表（MMSE）评分。[结果]与T1相比，三组患者的血清S100-β蛋白和NSE浓度在T2、T3时均明显升高（P＜0．05）；与T2、T3相比，三组患者的血清S100-β蛋白和NSE浓度在T4时均明显下降（P＜0．05）；A组和B组患者在T2、T3时的血清S100-β蛋白和NSE浓度均明显低于C组（P＜0．05），而A组和B组各时间点血清S100-β蛋白和NSE浓度无明显差异。C组患者术后d3认知功能降低的发生率明显高于A组和B组（P＜0．05）。[结论]远隔缺血时处理能抑制CPB瓣膜置换术患者S100-β蛋白和NSE的释放，并减少患者术后认知功能降低的发生。

Effect of Remote Ischemic Preconditioning on Brain Injury in Patients Undergoing Valve Re-placement Surgery with Cardiopulmonary Bypass

[Objective] To observe the effect of remote ischemic preconditioning on serum S100-β protein and neuron-specific enolase（NSE） levels in patients undergoing valve replacement surgery with cardiopulmo-nary bypass（CPB） ,and explore the relationship between remote ischemic preconditioning and postoperative neuropsychological dysfunction .[Methods] A total of 60 adult patients scheduled for valve replacement with CPB were randomly divided into remote ischemic treatment group（group A） ,remote ischemic preconditioning group（group B） and control group（group C） with 20 in each group .Ischemia and reperfusion conditioning was applied on right lower limb immediately after aortic occlusion in group A .But group B received the above treatment after anesthesia induction .Venous blood in right internal carotid was obtained and serum S100-βprotein and NSE levels were detected before surgery （T1 ） ,at CPB ending point（T2 ） ,5h（T3 ） and 24h（T4 ） af-ter CPB ending point ,respectively .Neurological signs were checked and MMSE scores were evaluated on day 1 before surgery ,day 3 and day 7 after surgery .[Results]Compared with T1 ,serum S100-βprotein and NSE levels at T2 and T3 in 3 groups were obviously elevated（ P＆lt;0 .05） .Compared with T2 and T3 ,serum S100-βprotein and NSE levels at T4 in 3 groups were obviously decreased（ P＆lt;0 .05） .Serum S100-βprotein and NSE levels in group A and group B at T2 and T3 were obviously lower than those in group C（ P＆lt;0 .05） ,but there was no significant difference in serum S100-βprotein and NSE levels at each time point between group A and group B .The incidence of the descending cognition in group C on day 3 after surgery was obviously higher than that in group A and group B （ P ＆lt;0 .05） .[Conclusion] Remote ischemic preconditioning can inhibit the release of S100-βprotein and NSE in patients undergoing valve replacement with CPB ,and reduce the incidence of postoperative cognition descending .