| Objective: Cardiovascular disease is a serious problem which threats health of global human. With the development of surgery technology, cardiac surgical procedures allow the treatment of cardiac diseases, which is entering a new phase.With the increase in the number of surgery, some new complications have arisen, such as postoperative cognitive dysfunction. As the population ages, the proportion of elderly people suffering from heart disease and consultation rate are rising year by year, and a large part of patients suffer from heart valve disease combining with coronary heart disease. POCD can sustainable for several days, weeks, or even develop into a permanent disease, which can serious affect the patient's postoperative recovery and the quality of living. Although there are many researches about POCD, but its pathogenesis is still unclear, prevention and treatment measures falling behind most seriously.Some researches suggesting disturbances in venous outflow from the cerebral circulation may result in brain injury. Severe increases in brain venous pressure lead to brain ischemia and, subsequently, brain edema and intracranial hemorrhages. The purpose of this study was to determine the changes in jugular venous pressure and to analyze its effect on perioperative brain injury measured by detecting of jugular bulb biomarkers, to observe whether it has an effect on early postoperative cognitive function in elderly patients. It can guide clinical practice in order to prevent POCD happening and improve the life quality and outcome of postoperative patients.Method: Collectted 46 patients in same surgery team who were undergoing elective valve replacment combined with coronary artery bypass grafting by cardiopulmonary bypass under general anesthesia. Aged 65~75, male or female, American Society of Anesthesiologists(ASA)class or ? ?, New York Heart Association(NYHA) class ? or ?, Central venous pressure(CVP) was measured using a jugular vein catheter, the right jugular vein was cannulated in retrograde fashion. Jugular venous pressure was measured in the jugular vein bulb(JVBP). Concentrations of jugular bulb plasma S100? protein, matrix metalloproteinase-9 protein, neurone specific enolase were measured as the markers of brain injury during the surgery and early postoperative period. Collected the values of regional cerebral oxygen saturation. Patients' cognitive function was evaluated by means of mini-mental state examination(MMSE) 1d before surgery, and 3d after surgery and 7d after surgery, 3m after surgery. Meanwhile in 3d after surgery, we use the confusion assessment method for diagnosis of delirium, who was diagnosed as delirium would be excluded from the trial. According to whether JVBP is greater than 12 mm Hg, patients were classified into two groups. Concentrations of jugular bulb plasma S100? protein, matrix metalloproteinase-9 protein, neurone specific enolase, the value of MMSE and r SO2 were compared in intraoperative and early postoperative.Results:Increased JVBP was noted after extracorporeal circulation. A significant increase over 12 mm Hg of JVBP increased plasma concentrations of S100? protein, MMP-9 and NSE(P<0.05). JVBP correlated with CVP, S100?, and MMP-9, NSE, r SO2. No patients were diagnosed as delirium.The MMSE values in two groups at 3,7 d and 3m after surgery were significantly lower than that before operation(P<0.05). The MMSE values of JVBP?12mm Hg at 3, 7 d and 3m after operation were significantly lower than that in group JVBP<12mm Hg(P<0.05). The incidence of postoperative cognitive dysfunction in group JVBP<12mm Hg were significantly lower than that in group JVBP?12mm Hg at 3, 7 d and 3m after operation(P<0.05).Conclusion: Cardiac surgery cause the increase of JVBP and JVBP > 12 mm Hg intensified an increase in brain injury biomarker concentrations, r SO2 decreased significantly, which may influence on elderly patients with early postoperative cognitive function. |
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