丁苯酞对非体外循环冠脉搭桥手术术后认知功能的影响

Effect of Butylphthalide on Cognitive Function after Off-Pump Coronary Artery Bypass Surgery

摘要: 目的：观察丁苯酞对非体外循环冠脉搭桥手术术后认知功能的影响。方法：选取2021年7月~2022年2月于青岛大学附属医院择期进行非体外循环冠脉搭桥手术的患者80例，ASA分级为II~III级，随机分为丁苯酞组和对照组，各40例。丁苯酞组在常规全身麻醉基础上于麻醉诱导后15分钟开始静脉滴注丁苯酞氯化钠注射液50 mg，对照组在常规全身麻醉基础上于麻醉诱导后15分钟开始静脉滴注等容量生理盐水。检测两组患者术前1天与术后1天、3天血清肿瘤坏死因子α (TNF-α)、白细胞介素-6 (IL-6)、S-100β蛋白和神经元特异性烯醇化酶(NSE)水平，并采用简易精神状态评价量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估病人认知功能。结果：2组患者外周血肿瘤坏死因子α (TNF-α)、白细胞介素-6 (IL-6)、S-100β蛋白、神经元特异性烯醇化酶(NSE)水平在术后1天和术后3天均较术前有不同程度的升高(P < 0.05)；丁苯酞组外周血肿瘤坏死因子α (TNF-α)、白细胞介素-6 (IL-6)、S-100β蛋白和神经元特异性烯醇化酶(NSE)水平在术后1天和术后3天均明显低于对照组(P < 0.05)；丁苯酞组术后1天、3天MMSE和MoCA评分明显高于对照组；丁苯酞组术后认知功能障碍的发生率为17.5%，对照组术后认知功能障碍的发生率为55%，丁苯酞组术后认知功能障碍的发生率明显低于对照组(P < 0.05)。结论：丁苯酞能改善非体外循环冠脉搭桥病人术后认知功能，降低术后认知功能障碍的发生率，其机制可能与减轻机体炎症反应有关。

Abstract: Objective: To observe the effect of butylphthalide on cognitive function after off-pump coronary ar-tery bypass surgery. Methods: A total of 80 patients selected for off-pump coronary artery bypass surgery in The Affiliated Hospital of Qingdao University from July 2021 to February 2020 were se-lected, with American Society of Anesthesiologists (ASA) II-III, and randomly divided into bu-tylphthalide group and control group, with 40 patients in each group. In the butylphthalide group, intravenous infusion of butylphthalide sodium chloride injection 50 mg was started 15 minutes af-ter induction of anesthesia on the basis of conventional general anesthesia, while in the control group, intravenous infusion of isovolume normal saline was started 15 minutes after induction of anesthesia on the basis of conventional general anesthesia. Serum levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), S-100β protein and neuron specific enolase (NSE) in 2 groups were detected 1 day before surgery, 1 day after surgery and 3 days after surgery. Cognitive function was assessed by Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA). Results: The levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), S-100β protein and neuron specific enolase (NSE) in peripheral blood of 2 groups were increased 1 and 3 days after surgery compared with those before surgery (P < 0.05). The levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), S-100β protein and neuron specific enolase (NSE) in peripheral blood of butylphthalide group were significantly lower than those of control group 1 and 3 days after sur-gery (P < 0.05). MMSE and MoCA scores of butylphthalide group were significantly higher than those of control group at 1 and 3 days after operation. The incidence of postoperative cognitive dysfunc-tion was 17.5% in the butylphthalide group and 55% in the control group, and the incidence of postoperative cognitive dysfunction in the butylphthalide group was significantly lower than the control group (P < 0.05). Conclusion: Butylphthalide can improve postoperative cognitive function and reduce the incidence of postoperative cognitive dysfunction in patients with off-pump coronary artery bypass grafting, and the mechanism may be related to the reduction of inflammatory re-sponse.