Objective To evaluate the protective effects of methylprednisolone combined with dexmedetomidine of cardiac valve replacement in patients with brain cognitive function under cardiopulmonary bypass (CPB).Methods Sixty patients for heart valve replacement in Affiliated Hospital.Inner Mongolia Medical University were randomly divided into four groups (n =15 each):group A control,methylprednisolone group (group M),dexmedetomidine group (Group D) and methylprednisolone combined with dexmedetomidine group (group B).After the induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Methylprednisolone 20mg/kg was administered to the CPB circuit prime in group M.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μg/(kg · h) until the end of operation in group D.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μ g/(kg · h) until the end of operation and methylprednisolone 20mg/kg was also administered to the CPB circuit prime in group B.At the same time the equal volume of normal saline was given in group A.After induction (T1),CPB instantly (T2),CPB 30min (T3),l0min after CPB(T4),at the end of operation(T5),6h after CPB (T6),the jugular bulb venous blood samples were taken for testing the serum concentrations of interleukin-6 (IL-6),interleukin-10 (IL-10),S100βprotein and neuron-specific enolase (NSE) using the method of ELISA.Simplified mini-mental state examination (MMSE) is used to assess the cognitive function of patients in pre-operation and 2days,3days as well as 7days after operation.Results At T1-6,IL-6,S100 protein and NSE in group M,group D and group B were significantly lower than those in control group,IL-10 was higher than that in control group,and there was significant difference (P ＜ 0.05).In B group at all time points IL-6 、S100 protein and NSE were lower than those in other groups,IL-10 was higher than other groups,and there was significant differences (P ＜ 0.05).The incidence of postoperative cognitive dysfunction in group M,group D and group B was higher than that in control group,and the incidence of cognitive dysfunction in B group was lowest,and there were significant differences (P ＜ 0.05).Conclusion Methylprednisolone and dexmedetomidine can effectively reduce the concentration of IL-6,S100 protein and NSE in cardiopulmonary bypass,reduce brain injury and the incidence of postoperative cognitive dysfunction.The protective effect on cerebral injury is better when using dexmedetomidine combined with methylprednisolone under cardiopulmonary bypass (CPB).

Objective To evaluate the effect of ABO blood group factor on anticoagulation with aspirin.Methods Seventy-three patients of both sexes,aged 45-70 yr,who did not take aspirin recently,were divided into 4 groups according to the blood group:blood group A group (group A,n=18),blood group B group (group B,n=20),blood group AB group (group AB,n=15),and blood group O group (group O,n =20).Aspirin 100 mg/d was taken orally for 2 weeks.Fasting blood samples were taken from the peripheral vein before administration (T1) and at 2 weeks after administration (T2) for measurement of activated partial thromboplastin time (APTT),thrombin time (TT),prothrombin time (PT),fibrinogen (Fib),platelet count (Plt) and platelet aggregation rate.Results There was no significant difference in Plt at T1,2 or platelet aggregation rate at T1 among the four groups (P＞0.05).Compared with A,B and AB groups,PT,APTT and TT were significantly prolonged and Fib was decreased at T1,and platelet aggregation rate was decreased at T2 in group O (P＜0.05).Compared with the baseline at T1,no significant change was found in PT,APTF,TT,Fib or Plt at T2 (P＞0.05),and platelet aggregation rate was significantly decreased at T2 in the four groups (P＜0.05).Conclusion ABO blood group factor is related to the individual variation in anticoagulation with aspirin,patients of A,B and AB blood group have the same sensitivity to anticoagulation with aspirin,and patients of O blood group are more sensitive to anticoagulation with aspirin.