Cerebral Protective Effects Of Cattle Encephalon Glycoside And Ignotin Injection In Patients Undergoing Cardiac Valve Replacement With Cardiopulmonary Bypass

Objective: Cerebral dysfunction remains to be a major source of morbidity after cardiac surgery. Cattle encephalon glycoside and ignotin injection is a compound of gangliosides which used to treat stroke and spinal injury. Its effect in cardiac surgery is uncertain. The aim of this study is to investigate the cerebral protective effects of cattle encephalon glycoside and ignotin injection in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Material and Methods: Forty patients undergoing cardiac valve replacement with CPB were randomly divided into two groups: cattle encephalon glycoside and ignotin injection group (group A, n = 20) and control group (group B, n = 20). Patients who had medical history of endocarditis, diabetes mellitus, hypertension, hyperlipoidemia, neurologic disease, immunologic disease or mental disorder were excluded. In group A cattle encephalon glycoside and ignotin injection 20ml was given i.v. after induction of anesthesia. In group B normal saline was given instead of cattle encephalon glycoside and ignotin injection. The hemodynamic change was recorded. Blood samples were taken from jugular bulb after induction of anesthesia (T1), discontinuation of CPB (T2), 2h, 6h and 24 h (T3, T4 and T5) after discontinuation of CPB for determination of serum levels of S-100B protein , neuron specific enolase (NSE), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α(TNF-α). Blood samples were also taken after induction of anesthesia (t1) , 33℃cooling (t2) , stable hypothermic duration (t3), 33℃rewarming (t4) , discontinuation of CPB (t5) and discontinuation of operation (t6) for determination of arterial and jugular bulb blood gas, glucose and lactate (Lac) concentration. Utilization of glucose (G_a-jv) and cerebral extraction rate of oxygen (COE) were calculated.Results: (1) There was no hemodynamic change during the infusion of the drug in both groups. (2) Serum levels of S-100B protein and NSE were significantly increased after CPB. At time of T5, serum levels of S-100B protein decreased to near baseline (T1), but serum levels of NSE remained high in both groups. At time of T2, T3, T4 and T5 , serum levels of S-100B protein were significantly higher in group B than in group A (P<0.05). At time of T2, T3 and T4, serum levels of NSE were significantly higher in group B than in group A (P<0.05). (3) Serum levels of IL-6, IL-8 and TNF-αwere significantly increased after CPB. At time of T3, T4 and T5, serum levels of IL-6 and IL-8 were significantly higher in group B than in group A (P<0.05). At time of T2,T3,T4 and T5, serum levels of TNF-αwere significantly higher in group B than in group A . (4) At points t2 and t3, COE and G_a-jv in two groups were markedly lower than that at t1 (P<0.05). At point t2, COE and G_a-jv were significantly higher in group A than in group B (P <0.05). Serum levels of Lac increased after beginning of CPB and reached peak value at discontinuation of CPB, At point t4, t5and t6, serum levels of Lac were significantly lower in group A than in group B (P <0.05).Conclusion: Cattle encephalon glycoside and ignotin injection could decrease the serum levels of S-100B protein, NSE, IL-6, IL-8 and TNF-α. It may increase COE and glucose utilization during cooling and decrease the serum level of lactate. It showed some degree of cerebral protective effect during cardiac valve replacement with CPB.