目的 观察银杏叶提取物对脑膜瘤切除术患者血清神经元特异性烯醇化酶(NSE)、S100β蛋白、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、超氧化物歧化酶(SOD)、丙二醛(MDA)含量及术后早期认知功能的影响.方法 选择择期行脑膜瘤切除术患者60例,采用随机数字表法分为两组:银杏叶提取物组(G组)和对照组(C组),每组30例.G组于麻醉诱导前30 min给予银杏叶提取物,C组给予等量生理盐水.分别于麻醉诱导前30 min(T1)、手术结束拔管时(T2)、术后24h(T3)三个时点采集静脉血,测定血清中NSE、S100β、TNF-α、IL-6、SOD、MDA的浓度.术前1d与术后3d分别使用简易精神状态测试量表、韦氏成人智力量表和记忆量表评估患者的认知功能状态.结果 与T1时比较,T2、T3时两组患者血清NSE、S100β、TNF-α、IL-6、MDA浓度升高,SOD浓度降低(P<0.05);与C组比较,T2、T3时G组血清NSE、S100β、TNF-α、IL-6、MDA浓度更低,SOD浓度更高(P<0.05);与术前1d比较,术后3d两组患者MMSE量表、数字累加、数字广度(顺向)、词汇联想、数字符号替换评分明显降低,循迹连线时间明显升高.C组数字广度(逆向)、视觉再生评分明显降低(P<0.05).与C组比较,G组术后3d数字累加、数字广度(顺向与逆向)、视觉再生评分明显更高(P<0.05).术后3d认知功能障碍(POCD)的发生率G组明显低于C组(P<0.05).结论 银杏叶提取物预处理可降低脑膜瘤切除术患者早期POCD的发生率,其机制可能与减轻炎性反应及抗氧化作用有关.
Objective To investigate the effects of ginkgo biloba extract on the early postoperative cognitive function and the serum neuron specific enolase (NSE),S100β,tumor necrosis factor-α (TNF-α),interleukin (IL)-6,superoxide dismutase (SOD) and malondialdehyde (MDA) in patients with meningioma resection.Methods 60 patients with meningioma scheduled for elective intracranial tumor resection were enrolled and randomly divided into two groups (n =30 each):ginkgo biloba extract group (group G) and control group (group C).Ginkgo biloba extract was infused intravenously 30 min before anesthesia induction in group G,while group C received the equal volume of normal saline.Venous blood sample were taken at three time points:30 min before induction (T1),extubation (T2) and 24 h after operation (T3)for determination of serum concentration of NSE,S100β,TNF-α,IL-6,SOD and MDA.Cognitive function was evaluated at 1 d before and 3 d after surgery using Mini-mental State Examination (MMSE),Wechsler Adult Intelligence Scale (WAIS) and Wechsler Memory Scale (WMS).Results Compared with T1,the concentration of NSE,S100β,TNF-α,IL-6 and MDA in serum were significantly increased at T2 and T3 in the two groups,while SOD was decreased (P < 0.05).Compared with group C,the concentration of NSE,S100β,TNF-α,IL-6 and MDA were significantly decreased at T2 and T3 in group G,while SOD was increased (P < 0.05).Compared with 1 d before surgery,the scores of MMSE,digit accumulation,digit breadth (forward),vocabulary association and digit symbol replacement were significantly decreased and tracing connection time was significantly increased on the 3rd day after surgery in the two groups.The scores of digital breadth (reverse) and visual regeneration were significantly decreased in group C (P < 0.05).Compared with group C,the scores of digit accumulation,digit breadth (forward and reverse) and visual regeneration were significantly increased on the 3rd day after surgery in group G (P < 0.05).The incidence of postoperative cognitive dysfunction (POCD) at 3 d after surgery in group G was significantly lower than group C (P < 0.05).Conclusions The pretreatment of ginkgo biloba extract can decrease the incidence of early POCD in patients with meningioma resection,and its mechanism may be related to the reduction of inflammatory reaction and antioxidation.