Effects of jugular vein bulb pressure on postoperative cognitive function in elderly patients undergoing valve replacement-coronary artery bypass grafting under cardiopulmonary bypass
10.3760/cma.j.cn131073.20191106.00506
- VernacularTitle:颈静脉球部压力对CPB下瓣膜置换术-冠状动脉旁路移植术老年患者术后认知功能的影响
- Author:
Peng SUN
1
;
Wenqian ZHAI
;
Jianxu ER
;
Jiange HAN
Author Information
1. 天津市胸科医院麻醉科 300222
- From:
Chinese Journal of Anesthesiology
2020;40(5):538-542
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of jugular vein bulb pressure (JVBP) on postoperative cognitive function in elderly patients undergoing valve replacement-coronary artery bypass grafting under cardiopulmonary bypass (CPB).Methods:Ninety-two patients of both sexes, aged 65-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, were selected.All the patients underwent right internal jugular vein catheterization to monitor central venous pressure (CVP) and retrograde catheterization to measure JVBP.JVBP was recorded immediately after anesthesia induction (T 11), 10 min after CPB (T 12) and at the end of operation (T 13). The patients were divided into 2 groups according to JVBP: JVBP<12 mmHg group (group L) and JVBP≥12 mmHg group (group H). At T 11-13 and on 1st and 2nd days after operation (T 14, 15), heart rate, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded, and blood samples from the jugular vein bulb were collected to determine the concentrations of S100β protein and matrix metalloproteinase-9 (MMP-9) in plasma and nerve specific enolase (NSE) in serum.Cognitive function was evaluated by Mini-Mental State Examination (MMSE) at 1 day before operation (T 21), 3 and 7 days after operation (T 22, 23) and 3 months after operation (T 24). Results:A total of 80 patients were included in this study, including 46 patients in group L and 34 patients in group H. Compared with those at T 11, CVP, JVBP, and concentrations of S100β protein and MMP-9 in plasma and NSE in serum were significantly increased at T 12 in group H, and CVP at T 13-15 and JVBP at T 12, 13 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 12-15 were significantly increased in two groups ( P<0.05). MMSE scores were significantly lower at T 22, 23 than at T 21 in the two groups ( P<0.05). Compared with group L, JVBP at T 12, 13, CVP at T 12-14 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 13 were significantly increased, concentrations of S100β prote in plasma were increased at T 12, MMSE scores were decreased at T 22-24, and the incidence of POCD was increased in group H ( P<0.05). JVBP was positively correlated with CVP, plasma S100β protein, MMP-9 concentration and serum NSE concentration, and the r values were 0.95, 0.56, 0.70 and 0.58, respectively ( P<0.05). Conclusion:Increased JVBP can decrease the postoperative cognitive function of elderly patients undergoing valve replacement-coronary artery bypass grafting under CPB, and the mechanism is related to blood-brain barrier damage.
