Effects Of Butylphthalide On Cognitive Function After Off-pump Coronary Artery Bypass Surgery

PurposeButylphthalide is an active ingredient extracted from the edible plant celery seed,which is widely used in the treatment of acute stroke.Animal experiments have demonstrated that butylphthalide can improve cognitive function in rats with cerebral ischemia by reducing oxidative stress injury,but there are no clinical experiments to demonstrate the effect of butylphthalide on patients’postoperative cognitive function.The aim of this experiment was to observe the effect of butylphthalide on improving cognitive function in non-extracorporeal circulation coronary artery bypass graft patients in order to improve their postoperative quality of life.MethodsA total of 100 patients with ASA class II-III coronary artery disease,were selected to undergo non-extracorporeal circulation coronary artery bypass surgery under general anesthesia at the Affiliated Hospital of Qingdao University.Simple Mental State Scale（MMSE）and Montreal Cognitive Assessment Scale（Mo CA）scores were administered on the day before surgery,and patients’gender,age,and underlying disease were recorded.All patients were randomly and equally divided into the butylphthalide experimental group and the physiological saline control group,with 50 patients in each group.Intravenous access was established after patients entered the operating room,and ECG,heart rate,pulse oximetry,and invasive blood pressure were monitored.Patients in both groups were induced with propofol 1mg/kg,etomidate 0.3mg/kg,midazolam 0.05mg/kg,phenylsulfonyl cisatracurium 0.3mg/kg,and sufentanil 1μg/kg for anesthesia.After the patient’s consciousness disappeared,the patient was intubated orally,and the ventilator parameters were adjusted.The tidal volume was 6-7 m L/kg,the respiratory rate was10-18/min,the inspiratory-to-expiratory ratio was 1:1.5-2,and the end-expiratory CO₂was maintained at 35-45 mm Hg（1 mm Hg=0.133 k Pa）.A right internal jugular vein was punctured and a triple-venous catheter was placed to measure central venous pressure and pump vasoactive drugs.Propofol 4-12mg/kg/h and phenylsulfonyl cisatracurium0.1mg/kg/h were pumped continuously intravenously,and sufentanil was injected intermittently as needed.Intraoperative EEG BIS was monitored and maintained between40 and 60.In the butylphthalide group,50mg of butylphthalide sodium chloride injection was administered intravenously 15 minutes after induction of anesthesia,and in the control group,equal volume of saline was administered intravenously 15 minutes after induction of anesthesia.The heart rate（HR）,mean arterial blood pressure（MAP）,central venous pressure（CVP）,and electroencephalographic bifrequency index（BIS）values were recorded at five time points:T0（before induction of anesthesia）,T1（before chest opening）,T2（anterior descending branch）,T3（posterior descending branch）,and T4（before sutured skin）in both groups.Patients were given Simple Mental State Examination Scale（MMSE）and Montreal Cognitive Assessment Scale（Mo CA）scores 1day before,1 and 3 days after surgery and venous blood was drawn to detect tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,S100βprotein,and serum neuron-specific enolase（NSE）levels by enzyme-linked immunosorbent assay（ELISA）.ResultsThe incidence of POCD was 17.5%in butylphthalide experimental group patients and55%in the control group patients.The differences in vital signs（HR,MAP,CVP,BIS）and operative time at different time points（T0-T4）between the two groups were not statistically significant.The levels of TNF-α,IL-6,S-100βprotein,and NSE were significantly higher in both groups on postoperative day 1 and postoperative day 3compared with preoperative day 1,with statistically significant differences（all P<0.05）.At postoperative day 1 and postoperative day 3,TNF-α,IL-6,S-100βprotein,and NSE levels were lower in butylphthalide experimental group compared with the control group,and the differences were statistically significant（all P<0.05）.In the follow-up of postoperative MMSE and Mo CA scores,patients in both groups had the lowest scores on the first postoperative day;compared with the control group,patients in butylphthalide experimental group had greater MMSE and Mo CA scores than the control group on the 1and 3 postoperative days（all P<0.05）.ConclusionThe incidence of cognitive dysfunction after non-extracorporeal circulation coronary artery bypass surgery is high,and butylphthalide can reduce inflammatory response during operation,reduce perioperative brain injury and decrease the incidence of cognitive dysfunction after coronary artery bypass surgery.