Abstract
BackgroundPostoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass (CPB).MethodsThis prospective, randomized, controlled trial was conducted from September 2014 to January 2017. Eighty-eight patients receiving cardiac valve replacement under CPB were randomized into the control (C) or the SMI (S) group. SMI (0.6 mL/kg) was administered intravenously from the time of anesthesia induction to the beginning of CPB. Cognitive function was assessed at 3 days before surgery and 3 days, 7 days, and 1 month after surgery using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) score. The serum levels of neuroglobin (Ngb), hypoxia-inducible factor-1α (HIF-1α), and neuron-specific enolase (NSE) were measured at 30 min after induction (T0), immediately after the endonasal temperature rewarmed to 36 °C (T1), and 1 h (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after CPB.ResultsCompared with the baseline values at T0, the serum Ngb levels in group C were significantly decreased at T1–2 and then increased at T3–6, while the levels in group S were decreased at T1–2 and increased at T4–6, compared to group C (p < 0.05). The serum HIF-1α levels at T1–4 and the serum NSE levels at T1–6 were significantly increased in both groups (p < 0.05). The serum levels of Ngb at T3, HIF-1α at T1–3, and NSE at T3–4,6 were lower in group S, compared to group C (p < 0.01). The MoCA-BJ scores were decreased at 3 and 7 days after surgery in both groups, and the MoCA-BJ scores in group S were higher than those in group C at 3 and 7 days after surgery (p < 0.01).ConclusionCognitive function is impaired postoperatively in patients who have undergone cardiac valve replacement under CPB. In addition, treatment with the traditional Chinese medicine SMI decreases the serum levels of Ngb, HIF-1α, and NSE as well as attenuates cognitive dysfunction.Trial registrationThis trial was registered with Clinicaltrials.gov as ChiCTR-TRC-14004373 on March 11, 2014.
Highlights
Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients
Oxygenation and upregulation of neuroglobin (Ngb) and hypoxia-inducible factor-1α (HIF-1α) expression have been considered as a protective mechanism responding to ischemic injury to neurons, while neuron-specific enolase (NSE) is a marker of neuronal damage
Hemodynamic parameters In comparison to T0, the mean arterial blood pressure was decreased at T1 (p < 0.001) and increased at T4,6 (p = 0.005 and p = 0.041) in group C, while it was decreased at T1,3 (p < 0.001 and p = 0.021) and increased at T4–6 (p = 0.002, p = 0.002, and p = 0.006) in group S
Summary
Postoperative cognitive dysfunction (POCD) is a common complication after cardiac surgery that influences the clinical outcomes and quality of life of patients. This study aimed to evaluate the effects of Shenmai injection (SMI) on POCD of patients who underwent cardiac valve replacement under cardiopulmonary bypass (CPB). Postoperative cognitive dysfunction (POCD) is considered as a common complication of cardiovascular surgery and causes several adverse effects, such as a delayed long-term recovery, a reduced quality of life, and an increased mortality rate [1, 2]. Whether circulating Ngb, HIF-1α, and NSE levels could serve as early indicators for cognitive dysfunction after cardiac surgery has not been reported. Reports concerning the effects of SMI on cognitive function in patients undergoing cardiac valve replacement under CPB are not available
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