摘要目的观察浅低温体外循环(CPB)心内直视手术中颅内静脉血中S-100蛋白和NSE的含量变化.方法择期心内直视手术病人15例,于CPB开始前(A点),鼻咽温(NPT)降温稳定期(B点),复温至NPT 36℃(C点),CPB结束后30min(D点),CPB结束后4～6h(E点),CPB结束后24h(F点)经左颈内静脉逆向置管于颈内静脉球部,取血样检测S-100蛋白和NSE的含量.结果 CPB开始后病人颅内静脉血中S-100蛋白和NSE含量显著增加(P＜0.01),在复温期或停机后30min达到峰值,以后逐渐下降,停机后24h S-l00蛋白和NSE已接近正常水平.结论 CPB可引起S-100蛋白和NSE的释放,提示有脑损伤发生;CPB后24h血浆S-100蛋白和NSE浓度未有显著升高者则无明显神经系统并发症发生.

abstractsObjective It was estimated that about 70% patients suffered from mild brain function disturbances after cardiac surgery with CPB. Methods for early detection of brain injury after CPB in current use like EEG, transcranial Doppler, CT, MRI are expensive and not sensitive. It was repored that combined assays of S-100 protein and NSE were conducive to early detection of brain ischemic injury and prediction of the prognosis. The purpose of this study was to assess the changes in cerebral blood S-100protein and NSE levels during and after open heart surgery with mild hypothermic CPB.Methods 15consecutive ASA Ⅱ-Ⅲ patients undergoing elective open heart surgery under CPB were studied. Aortic cross-clamping time was 30-60 min and CPB time was less than 120 min. Patients with hypertension and neurologic or endocrine diseases were excluded. Anesthesia was induced with midazolam 0.15mg/kg,fentanyl 5μg/kg and vecuronium 0.1mg/kg. Fentanyl 30-50 μg/kg was continuously infused after tracheal intubation and during CPB. Vecuronium was given intermittently to maintain muscle relaxation.Midazolam was infused at 0.2mg@ kg-1. h-1 during CPB. Temperature was reduced to 32℃-35℃ during CPB. Aterial blood pH and PCO2 were maintained within normal range and Hct between 25 %-30 % during CPB. Internal jugular vein was caunulated and the catheter was advanced retrogradely until jugular bulb.Jugular venous blood samples were taken for determination of S-100 protein and NSE content before CPB (A), when mild hypothermia (32℃-35℃) was steadily maintained (B), rewarming to 36℃ (C), 30 min (D), 4-6h (E) and 24h (F) after termination of CPB. Results (1) After institution of CPB, S-100protein level increased significantly (P ＜ 0.01 ) and peaked during rewarming and then returned to baseline level 24h after CPB. (2) NSE level increased after CPB was begun (P ＜ 0.05) and peaked at 30 min after CPB and then gradually decreased. It was still slightly higher than the baseline value 24h after CPB. (3)No significant cognitive disturbances were seen after CPB. Conclusions CPB initiates release of S-100protein and NSE which implies cerebral injury during CPB. In patients without obvious cerebral injury thereis no significant increase in S-100 protein and NSE concentrations 24h after CPB.