不同时相远隔缺血预处理对颈动脉内膜剥脱术患者术后认知功能及脑损伤的影响

袁海军; 黄晓霞; 蓝志坚; 傅理; 彭文勇

doi:10.16766/j.cnki.issn.1674-4152.002588

不同时相远隔缺血预处理对颈动脉内膜剥脱术患者术后认知功能及脑损伤的影响

doi: 10.16766/j.cnki.issn.1674-4152.002588

金华市中心医院麻醉科，浙江金华 321000

基金项目:

浙江省医药卫生科技计划项目 2020KY345

2021年度公益类金华市科学技术研究计划项目 2021-4-006

详细信息

通讯作者:
袁海军, E-mail: yuanhaijun2022@163.com

中图分类号: R743
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出版历程
- 收稿日期: 2022-04-06
- 网络出版日期: 2022-09-26

Effects of different phase remote ischemic preconditioning on postoperative cognitive function and brain injury in patients with carotid endarterectomy

Department of Anesthesiology, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的探讨颈动脉内膜剥脱术(CEA)采用不同时相远隔缺血预处理(RIPC)对患者术后认知功能、脑损伤的影响。方法选取2020年6月—2021年7月金华市中心医院收治的60例颈动脉重度狭窄患者，择期行颈动脉内膜剥脱术，按随机数字表法分为A组(术前1 h行RIPC方案)和B组(术前24 h行RIPC方案)，每组30例，比较2组患者神经、认知功能，血清中枢神经特异性蛋白(S100-β)、脑源性神经营养因子(BDNF)、炎症因子、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)及并发症情况。结果 2组患者MMSE评分各时间点间、组间、组和时间的交互作用差异均有统计学意义(F=3.302、4.321、8.717，均P＜0.05)；术后1个月，B组患者MMSE评分[(28.54±1.44)分]明显优于A组[(27.35±1.31)分，P＜0.05]。术后24 h B组患者BDNF水平[(4.92±0.51)ng/mL]高于A组[(3.56±0.13)ng/mL，P＜0.05]。术后24 h，2组患者IL-6、hs-CRP水平较术前1 d有所提高(均P＜0.05)；2组患者SBP、DBP、MAP、HR各时间点间、组间、组别和时间的交互作用差异均有统计学意义(均P＜0.05)。A组认知功能降低发生率为16.67%，高于B组的10.00%，差异无统计学意义(P＞0.05)。结论术前24 h实施RIPC能有效缓解CEA后脑损伤情况，提升患者神经、认知功能。
- 颈动脉内膜剥脱术 /
- 远隔缺血预处理 /
- 认知功能 /
- 不同时相 /
- 神经功能 /
- 血清 /
- 并发症
Abstract: Objective To investigate the effects of different phases of remote ischemic preconditioning (RIPC) on cognitive function and brain injury after carotid endarterectomy (CEA). Methods Sixty patients with severe carotid stenosis treated in Jinhua Central Hospital from June 2020 to July 2021 were randomly divided into group A (RIPC scheme 1 h before operation) and group B (RIPC scheme 24 h before operation), with 30 patients in each group. The neurological and cognitive functions and serum central nerve specific protein (S100) of the two groups were compared, including brain-derived neurotrophic factor (BDNF), inflammatory factors, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (map), heart rate (HR) and complications. Results Significant differences were noted in the interaction between the two groups at each time point, between groups and between groups and time (F=3.302, 4.321, 8.717, all P < 0.05). One month after operation, the MMSE score of group B [(28.54±1.44) points] was significantly better than that of group A [(27.35±1.31) points, P < 0.05]. The level of BDNF in group B [(4.92±0.51) ng/mL] was higher than that in group A [(3.56±0.13) ng/mL, P < 0.05]. At 24 h after operation, the levels of IL-6 and hsCRP in the two groups were higher than those at 1 day before operation (all P < 0.05). Significant differences were found in the interaction of SBP, DBP, map and HR between groups, groups and time between the two groups (all P < 0.05). The incidence of cognitive impairment was 16.67% in group A and 10.00% in group B. The difference between the two groups was not significant (P>0.05). Conclusion The implementation of RIPC 24 h before operation can effectively alleviate brain injury after CEA and improve the neurocognitive function of patients.
- Carotid endarterectomy /
- Remote ischemic preconditioning /
- Cognitive function /
- Different phases /
- Neurological function /
- Serum /
- Complication

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表 1 2组重度颈动脉狭窄患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients with severe carotid artery stenosis

组别	例数	性别(例)		年龄(x ±s，岁)	BMI(x ±s)	麻醉风险评级(例)		颈动脉内膜切除(例)		手术时间(x ±s，min)
组别	例数	男	女	年龄(x ±s，岁)	BMI(x ±s)	Ⅱ级	Ⅲ级	左侧	右侧	手术时间(x ±s，min)
A组	30	17	13	66.63±8.27	23.41±2.58	12	18	14	16	97.55±6.12
B组	30	18	12	67.23±8.04	23.55±2.45	13	17	15	15	100.02±5.45
统计量		0.069^a		0.285^b	0.216^b	0.069^a		0.067^a		1.651^b
P值		0.793		0.777	0.830	0.793		0.796		0.104
注：^a为χ²值，^b为t值。

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表 2 2组重度颈动脉狭窄患者神经、认知功能比较(x ±s，分)

Table 2. Comparison of neurological and cognitive functions between two groups of patients with severe carotid artery stenosis (x ±s, scores)

组别	例数	术前1 d	术后7 d	术后1个月	F值	P值
A组	30	26.61±2.23	26.53±1.88	27.35±1.31	1.799	0.172
B组	30	26.77±2.12	27.32±2.19	28.54±1.44^a	6.499	0.002
t值		0.285	1.499	3.348
P值		0.777	0.139	0.001
注：与同组术前1 d、术前7 d比较，^aP＜0.05。

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表 3 2组重度颈动脉狭窄患者血清S100-β蛋白、BDNF比较(x ±s)

Table 3. Comparison of serum S100-β protein and BDNF in two groups with severe carotid artery stenosis(x ±s)

组别	例数	S100-β蛋白(μg/L)		BDNF(ng/mL)
组别	例数	术前1 d	术后24 h	术前1 d	术后24 h
A组	30	0.25±0.05	0.39±0.08^a	1.88±0.08	3.56±0.13^a
B组	30	0.24±0.04	0.36±0.09^a	1.85±0.07	4.92±0.51^a
t值		0.855	1.365	1.546	14.153
P值		0.396	0.178	0.128	＜0.001
注：与同组术前1 d比较，^aP＜0.05。

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表 4 2组重度颈动脉狭窄患者血清炎症因子比较(x ±s)

Table 4. Comparison of serum inflammatory factors between two groups of patients with severe carotid artery stenosis(x ±s)

组别	例数	IL-6(μg/L)		hs-CRP(mg/L)
组别	例数	术前1 d	术后24 h	术前1 d	术后24 h
A组	30	95.33±16.78	165.32±20.11^a	2.55±0.55	4.11±0.75^a
B组	30	94.99±16.75	160.26±20.13^a	2.61±0.62	4.05±0.77^a
t值		0.079	0.974	0.397	0.306
P值		0.938	0.334	0.693	0.761
注：与同组术前1 d比较，^aP＜0.05。

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表 5 2组重度颈动脉狭窄患者不同时间点SBP、DBP、MAP及HR比较(x ±s)

Table 5. Comparison of SBP, DBP, MAP and HR at different time points between two groups of patients with severe carotid artery stenosis(x ±s)

组别	例数	SBP(mm Hg)			DBP(mm Hg)
组别	例数	T1	T2	T3	T1	T2	T3
A组	30	126.24±9.50	119.77±10.86^a	134.22±13.40^a	71.35±8.12	63.79±10.38^a	75.49±11.46^a
B组	30	126.77±9.56	122.43±10.15^a	125.30±9.27	71.43±9.54	65.91±10.35^a	66.38±9.17
t值		0.215	0.980	2.998	0.035	0.785	3.400
P值		0.829	0.327	0.003	0.972	0.432	0.001

组别	例数	MAP(mm Hg)			HR(次/min)
组别	例数	T1	T2	T3	T1	T2	T3
A组	30	89.27±9.03	81.33±10.36^a	95.89±11.47^a	70.45±7.56	65.85±6.39^a	69.67±4.86
B组	30	89.60±8.11	84.97±10.75^a	85.17±11.20	70.46±5.84	68.12±5.93^a	66.85±6.51
t值		0.149	1.335	3.663	0.006	1.426	1.901
P值		0.882	0.182	＜0.001	0.995	0.154	0.057
注：与同组T1时比较，^aP＜0.05。

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