颅脑围手术期C反应蛋白的动态变化及其临床意义

目的探讨手术性脑损伤急性期C反应蛋白（CRP）的动态演变及其与临床和神经影像学的关系。方法采用免疫比浊法测定58例择期行颅脑手术患者的术前、术后第1、3、7、14天血清的CRP浓度,根据手术损伤程度、是否显微手术及临床和影像学上有无继发性脑损伤依次分组。结合临床、影像学和病理资料,观察各组CRP的动态变化,分析颅脑围手术期CRP的变化规律及其与手术损伤程度及继发性脑损伤（SBI）的关系。结果所有择期手术患者血清CRP于术后第1天均升高,随着病情的稳定及好转逐渐下降。脑膜瘤组于术后第1天及第3天高于颅骨缺损组（P〈0.05）,胶质瘤组于术后第1、3、7天高于脑膜瘤组（P〈0.05）;非显微手术组血清CRP峰值高于显微手术组（t=3.72,P〈0.05）。胶质瘤组于术后第14天降至正常,脑膜瘤组于第7天降至正常,颅骨缺损组于第3天降至正常,继发性脑损害组下降明显延迟。结论血清CRP是颅脑手术后判断急性期脑损伤的敏感指标,CRP的动态演变规律与临床病情和影像学变化之间存在内在关系。监测血清CRP对判断临床病情、早期发现并治疗继发性脑损害和评估颅脑手术损伤的严重程度有重要意义。

Dynamic Change in C Reactive Protein during Perioperative Period and Its Clinical Significance in Neurosurgical Patients

Objective To study the dynamic change in serum C reactive protein (CRP) during the perioperative period and its relationship with clinical neuroimaging in neurosurgical patients. Methods The serum levels of CRP were determined by immune nephelometry before craniotomy and 1, 3, 7 and 14 days after the operation in 58 patients undergoing selective operation, of whom, 46 suffered from intracranial tumors and 12 from skull defects. The patients were divided into both the microsurgical and non-microsurgical according to operative methods or both the secondary brain insult (SBI) and no secondary brain insult (nSBI) groups according to clinical manifestations and imagings. The relationship of the changes in serum CRP level with the operative injury and SBI was analysed. Results The serum CRP levels were elevated 1 day after the operation in all the patients, and then gradually decreased with improvement or stabilization of the patients' conditions. The CRP level was significantly higher in 21 patients with gliomas than that in 25 patients with meningiomas 1, 3 and 7 days after the operation (P<0.05). The CRP level was significantly higher in 25 patients with meningiomas than that in 12 patients with skull defect 1 and 3 days after the operation (P<0.05). The peak value of CRP in 13 patients with meningiomas undergoing non-microsurgery was significantly higher than that in 12 patients with meningiomas undergoing microsurgery (P<0.05). The CRP in skull defect group, meningioma group and glioma group returned to normal level 3, 7 and 14 days after the operation respectively. The decrease of CRP level was delayed dramatically in the patients with SBI. Conclusions The serum CRP level is a sensitive index of acute damage to brain induced by the operation. The dymamic change in the CRP level was definitely related to the changes in neuroimaging and patient's condition. The dynamic observation of the serum CRP level is helpful to judgment of the severity, earlier diagnosis and postoperative treatment of SBI in the patients undergoing the neurosurgery.