上肢远程缺血预处理对颈动脉内膜剥脱术患者脑损伤的保护作用
投稿时间:2018-02-23  修订日期:2018-03-10  点此下载全文
引用本文:刘万超,王晶晶,张萌,吴康丽,陈秀侠.上肢远程缺血预处理对颈动脉内膜剥脱术患者脑损伤的保护作用[J].医学研究杂志,2018,47(11):168-171
DOI: 10.11969/j.issn.1673-548X.2018.11.037
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作者单位E-mail
刘万超 221004 徐州医科大学  
王晶晶 221004 徐州医科大学  
张萌 221004 徐州医科大学  
吴康丽 221004 徐州医科大学  
陈秀侠 徐州医科大学附属医院 cxxlxy@sina.com 
中文摘要:目的 探讨上肢远程缺血预处理对颈动脉内膜剥脱术(CEA)患者脑损伤的保护作用。方法 选取择期行颈动脉内膜剥脱术患者40例,采用数字表法随机分为预处理组(R组,n=20)和对照组(C组,n=20)。R组在麻醉诱导后利用血压计充气囊至200mmHg,持续5min后放气,间隔5min再次重复,共3次。C组用袖带绑在上肢30min,不做任何处理。于术前和颈动脉开放后2、6、24、48h检测两组患者血清中的S100β蛋白和神经元特异性烯醇化酶(NSE)水平;比较两组患者术前1天和术后7天简易精神状态量表(MMSE)的评分,并观察术后并发症发生率。结果 两组内T1~T3各时间点的血清S100β蛋白和NSE水平均明显高于T0时间点(P<0.05),预处理组T1~T3各时点的血清S100β蛋白和NSE水平均明低于对照组相应时间点(P<0.05)。两组患者术后7天MMSE评分均明显低于术前1天(P<0.05),预处理组发生术后认知功能障碍(POCD)有1例(5%),对照组发生POCD有5例(25%)、脑梗死1例(5%)、脑出血1例(5%),组间总的并发症发生率比较差异有统计学意义(P<0.05)。结论 上肢远程缺血预处理可降低颈动脉内膜剥脱术患者血清中S100β蛋白和NSE水平,有效降低患者的脑损伤的程度,降低POCD的发生率,有效减少术后并发症的发生,具有一定的脑保护作用。
中文关键词:远程缺血预处理  颈动脉内膜剥脱术  脑保护
 
Protective Effects of Limb Remote Ischemic Preconditioning on Brain Injury in Patients during Carotid Endarterectomy
Abstract:Objective To investigate the protective effects of limb remote ischemic preconditioning on brain injury in patients during carotid endarterectomy. Methods Forty patients undergoing elective carotid endarterectomy were randomly divided into two groups: intervention group (group R, n=20) and control group (group C, n=20). After induction of anesthesia, group R was inflated an upper extremity blood pressure cuff for 3×5min to 200mmHg. Group C was tied to the upper limb for 30min with cuff, without any treatment. Serum levels of S100β protein and neuron-specific enolase (NSE) in the two groups were detected preoperatively and at 2h, 6h, 24h and 48h after declamping of carotid artery. The mini-mental state examination (MMSE) score was compared between the two groups before operation and 7 days after operation, and observe the incidence of postoperative complications. Results The serum levels of S100β protein and NSE from T1 to T3 were significantly higher than those of T0 in intervention group and control group (P<0.05). In intervention group, the S100β protein and NSE level from T1 to T3 were significantly lower than those of control group (P<0.05). The MMSE's value of day 7 after operation was significantly lower than that of basis (preoperative) in both groups. One patient (5%) suffered POCD in intervention group. In control group, five patients (25%) suffered POCD, one patient (5%) suffered cerebral infarction, and one patient (5%) suffered intracerebral hemorrhage. In intervention group, the overall incidence of complications were significantly lower than those of control group (P<0.05). Conclusion Limb remote ischemic preconditioning has some protective effects on brain, through decreasing the level of serum S100β and NSE during carotid endarterectomy patients. It also decsease the cerebral injury, Reducing the incidence of POCD, and reducing the incidence of postoperative complication seffectively.
keywords:Remote ischemic preconditioning  Carotid endarterectomy  Brain protention
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