摘要
目的评价体外循环(cPB)下心脏手术患者血浆S-100B蛋白水平的变化。方法选择拟行CPB辅助下冠状动脉搭桥术的患者,年龄60-77岁,体重55~75kg,身高153~175cm,ASA分级Ⅱ或Ⅲ级,美国国立卫生研究院卒中量表(NIHSS)评分〈10分。术后第2天再次行NIHSS评分,根据评分将患者分为3组:无症状组(A组)NIHSS评分0~9分;轻度脑损伤组(B组)NIHSS评分10~19分;中重度脑损伤组(C组)NIHSS评分20~45分。于CPB开始前(L)、CPB30min(T1)、CPB结束(T2)、CPB结束后1h(T1)、6h(T4)、24h(Ts)时取颈内静脉血样,测定血浆S-100β蛋白浓度。记录手术时间、CPB时间、主动脉阻断时间、ICU停留时间和住院时间。结果A组10例,B组10例,C组12例。与正常上限值(0.15μg/L)比较,A组B时、B组R—L时、C组,T1-T5时血浆S-100β蛋白浓度升高(P〈0.05)。三组CPB时和CPB结束后血浆S-100β蛋白浓度均升高,A组和B组T1时达峰值,C组T4时达峰值。A组、B组和C组CPB时和CPB结束后血浆S-100β蛋白浓度依次升高,手术时间、CPB时间、主动脉阻断时间、ICU停留时间以及住院时间依次延长(P〈0.05)。结论血浆S-10013蛋白是反映CPB心脏手术患者脑损伤及其程度的可靠生化指标,CPB结束后6h检测血浆S-100β蛋白水平对评价脑损伤程度及其预后更有意义。
Objective To evaluate the changes in plasma S-100β protein concentration in patients underg- oing cardiac surgery performed with cardiopulmonary bypass (CPB). Methods ASA 11 or m patients aged 60-77 yr weighing 55-75 kg with national institutes of health stroke scale(NIHSS) 〈 10 undergoing coronary artery bypass grafting with CPB were enrolled in this study. Cerebral function was evaluated and scored using NIHSS at 2 d after operation. The patients were divided into 3 groups according to NIHSS scores: group A uncomplicated (NIHSS score 0-9), group B mild brain injury (NIHSS score 10-19) and group C moderate and severe brain injury (NIHSS 20-45). Plasma S-100β protein concentration was measured before CPB, at 30 min of CPB, the end of CPB and 1 h, 6 h, 24 h after CPB. The duration of operation, CPB time, aortic cross-clamping time and length of ICU stay and hospital stay were recorded. Results Ten patients in groups A and B and 12 in group C completed the trial. Plasma S-100β protein concentration was significantly increased during and after CPB as compared with the baseline at To and peaked at T3 (groups A, B) and T4 (group C). The plasma S-100β protein concentration was highest in group C and lowest in group A. The duration of operation, CPB time, aortic cross-clamping time and length of ICU stay and hospital stay were longest in group C and shortest in group A. Conclusion Plasma S-100β protein concentration can be used as a marker of cerebral injury after cardiac surgery performed with CPB and the concentration measured at 6 h after CPB is more significant in evaluating the degree of cerebral injury and prognosis.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第1期31-33,共3页
Chinese Journal of Anesthesiology