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    瑞马唑仑对体外循环下瓣膜置换术病人脑损伤的影响

    Effect of remimazolam on brain injury in patients treated with valve replacement under cardiopulmonary bypass

      摘要
    • 摘要:
      目的 ：探讨瑞马唑仑对体外循环（CPB）下瓣膜置换术病人脑损伤的影响。
      方法 ：选取择期CPB下行瓣膜置换术病人60例，按随机数字表法分为瑞马唑仑组和丙泊酚组，各30例。瑞马唑仑组静脉予以瑞马唑仑（诱导0.2 ~ 0.3 mg/kg，维持0.5 ~ 1.0 mg·kg–1·h–1），丙泊酚组静脉予以丙泊酚（诱导1.5 ~ 3 mg/kg，维持2 ~ 3 mg·kg–1·h–1）。分别于CPB开始前（T1）、CPB结束后2 h（T2）、术后第3天（T3）、术后第7天（T4）经颈内静脉采集静脉血液5 mL，采用ELISA法测定血浆S-100β蛋白、神经元特异性性烯醇化酶（NSE）及Tau蛋白水平；术后第1、3天早上采集病人外周血，检测白细胞、中性粒细胞、C反应蛋白水平；分别于术前1 d（T0）、T3、T4采用简易精神状态测量量表（MMSE）和蒙特利尔认知功能评估量表（MoCA）评估病人认知情况。
      结果 ：2组病人T3、T4时MMSE、MoCA评分均较T0降低（P ＜ 0.05），且瑞马唑仑组T3、T4时MMSE、MoCA评分均明显高于丙泊酚组（P ＜ 0.01）。2组病人T2时血浆S-100β、NSE水平均较T1升高（P ＜ 0.05），T2 ~ T4时Tau均较T1升高（P ＜ 0.05）；与丙泊酚组相比，瑞马唑仑组T2时S-100β、NSE水平均明显降低（P ＜ 0.01），T2 ~ T4时Tau均明显降低（P ＜ 0.01）。术后第1、3天，瑞马唑仑组C反应蛋白水平均低于丙泊酚组（P ＜ 0.05），白细胞、中性粒细胞差异均无统计学意义（P ＞ 0.05）。
      结论 ：瑞马唑仑能够降低CPB下瓣膜置换术病人脑损伤程度，改善术后认知功能状况，其机制可能与减轻应激和全身炎症反应，抑制S-100β蛋白、NSE及Tau蛋白有关。

       

      Abstract:
      Objective To investigate the effects of remimazolam on brain injury in patients treated with valve replacement under cardiopulmonary bypass (CPB).
      Methods Sixty patients scheduled by valve replacement under CPB were divided into the remazolam group and propofol group according to the randomized numerical table method (30 cases each group). The remazolam group were intravenously injected with remazolam (induction 0.2–0.3 mg/kg, maintenance 0.5–1.0 mg·kg–1·h–1), and the propofol group were intravenously injected with propofol (induction 1.5–3 mg/kg, maintenance 2–3 mg·kg–1·h–1). The 5 mL of venous blood was collected via the internal jugular vein before the start of CPB (T1), 2h after the end of CPB (T2), postoperative 3 day (T3) and postoperative 7 day (T4), The levels of white blood cells, neutrophils and C-reactive protein in the peripheral blood of patients in the morning of the 1st and 3rd day after surgery were detected using ELISA. The patients' cognitive status were assessed by the Simple Mental State Measurement Scale (MMSE) and Montreal Cognitive Function Assessment Scale (MoCA) at 1 day before surgery (T0), T3 and T4, respectively.
      Results Compared with T0, the MMSE and MoCA scores at T3 and T4 decreased in two groups (P ＜ 0.05) and the MMSE and MoCA scores in the propofol group at T3 and T4 were significantly higher than those in remazolam group (P ＜ 0.01). Compared with the T1 time-point, the serum levels of S-100β and NSE in two gorups significantly increased at the T2 time-point (P ＜ 0.05), and the serum levels of Tau in two groups at the T2-T4 time point were significantly higher than that at T1 (P ＜ 0.05). Compared with the propofol group, the serum levels of S-100β and NSE at the T2 time-point significantly decreased (P ＜ 0.01), and the serum levels of Tau significantly at the T2-T4 time point decreased in the remazolam group (P ＜ 0.01). On the 1st and 3rd day after surgery, the level of C-reactive protein in the remazolam group was lower than that in propofol group (P ＜ 0.05), and there was no statistical significance in the levels of cleukocytes and neutrophils between two groups (P ＞ 0.05).
      Conclusions Remazolam can reduce the degree of brain injury and improve postoperative cognitive function in CPB valve replacement patients, and its mechanism may be related to reducing stress and systemic inflammatory response, inhibiting S-100β protein, NSE and Tau protein.

       

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