大面积脑梗死减压术后病人血清NSE、S100和乳酸变化及意义

目的 从生化方面探讨开颅减压术对于大面积脑梗死的疗效，并评价血清中神经元特异性烯醇化酶（NSE）、S100蛋白及乳酸的改变与大面积脑梗死减压术预后的关系。方法 大面积脑梗死病人49例，分为手术组及内科治疗组，内科治疗组给予脱水、支持及神经代谢药物、亚低温等常规治疗，手术组在常规治疗基础上于入院12h内行标准大骨瓣减压术。全部病人均于发病后12h内、36、72、120h采取静脉血，测定NSE、S100蛋白及乳酸的含量。结果 手术组存活病人术后血清NSE、S100蛋白含量升高幅度明显低于内科治疗组（t=2．53、3．04，P〈0．05），且达峰值后下降速度较快，与内科治疗组比较差异有显著性（t=2．11、4．27，P〈0．05）；而血清乳酸含量手术组术后3d内下降检测值明显低于内科治疗组，两组比较差异有显著性（t=2．15，P〈0.05）。术后死亡病人血清中NSE和S100蛋白水平较存活者明显升高（t=2．48、2．63，P〈0．05），而乳酸含量死亡病人达峰值后降低值明显低于存活者（t=2．22，P〈0．05）。结论 血清中的NSE、S100蛋白及乳酸含量的变化可以为早期去骨瓣减压术治疗大面积脑梗死的疗效判断及预后评估提供参考。

CHANGES OF SERUM NEURONSPECIFIC ENOLASE,S100 PROTEIN AND LACTATE IN PATIENTS WITH MASSIVE CEREBRAL INFARCTION AFTER DECOMPRESSIVE SURGERY

Objective To explore the effect of decompressive surgery for massive cerebral infarction （MCI） through changes of serum neuronspeeific enolase （NSE）, S100 protein and lactate,and evaluate the relation of the changes with the progno sis of the patients after decompressive surgery. Methods Forty nine patients with MCI were divided into surgical group and medical-treatment group. Patients in the medical group received dehydration,supportive therapy, neurometabolic drugs and sub hy pothermy. For those in surgical group underwent standard decompressive craniectomy, within 12 hours after admission,in addition to conventional therapy. Venous blood was collected from all the patients, within 12, 36, 72 and 120 hours after the onset,for detection of NSE, S100 protein and lactate. Results Postoperatively, the levels of NSE and S100 protein in the surgical group were lower than that in the medical group （t=2.53,3.04;P〈0.05）, and rate of decay from the peak was faster （t=2.11,4.27;P〈0.05）. The serum lactate was lower within three days after operation in the surgical group than that in the medical （t=2.15,P〈0.05）. The levels of NSE and S100 protein in those who died after surgery increased significantly （t=2.48, 2.63;P〈0.05）, but the decline of the level of lactate from the peak in patients who died was much slower （t=2.22, P〈0.05）. Conclusion The changes of serum levels of NSE, S100 protein and lactate can provide a reference for prediction of therapeutic effect and prognosis of patients with MCI undergoing early deeompressive surgery.