不同脑保护方法下主动脉术后脑脊髓液S100β及IL-6的变化

目的通过对主动脉手术围手术期脑脊髓液生化指标变化的比较,评价两种不同脑保护方法的效果。方法2004年11月至2005年4月接受手术治疗的主动脉瘤患者14例,其中I型主动脉夹层11例,Ⅲ型主动脉夹层2例,假性胸腹主动脉瘤1例。在单纯深低温停循环（DHCA）下行胸降主动脉替换5例（DHCA组）;在DHCA结合选择性顺行脑灌注（ASCP）下行主动脉弓部置换9例（ASCP组）。于术前及术后0、6、12、24、48和72h检测脑脊髓液S10013蛋白（S100β）及白细胞介素6（IL-6）水平。结果ASCP组停循环时间长于DHCA组。两组脑脊髓液中S100β及IL-6的术前水平无显著差别。两组S100β于术后12h达到峰值;术后6—72h各时间点两组S100β水平差异有统计学意义（P〈0．05）。两组IL-6分别于术后12h和0h达到峰值;术后6h及12h两组IL-6水平差异有统计学意义（P〈0．05）。结论在两种脑保护方法下主动脉手术中发生的缺氧性脑损伤均属轻型。DHCA结合单侧ASCP具有比单纯DHCA更好的脑保护效果,围手术期的脑损伤较轻。

Release of S100beta and IL-6 into cerebrospinal fluid after aortic operation assisted by two different cerebral protective methods

OBJECTIVE: To evaluate the clinical efficacy of two brain protective methods for aortic operation according to S100beta protein (S100beta) and interleukin-6 (IL-6) in cerebrospinal fluid (CSF). METHODS: From November 2004 to April 2005, 14 patients who underwent aortic operations with circulatory arrest were alternatively allocated to one of two methods of brain protection: only deep hypothermic circulatory arrest (core temperature, 18 degrees C) for descending thoracic aorta operations (group DHCA, n = 5) or selective antegrade cerebral perfusion (core temperature, 20 degrees C; flow rate, 10 ml kg(-1) min(-1)) for aortic arch operations with DHCA (group ASCP, n = 9). Indications for surgical intervention were Stanford type A dissection in 11 patients, Stanford type B dissection in 2 patients, false aneurysm on thoracoabdominal aorta in 1 patient. S100beta and IL-6 in CSF were assayed in all patients from each group before cardiopulmonary bypass, as well as 0, 6, 12, 24, 48, 72 h after the operation. RESULTS: There were no significant differences in lowest core temperature (P > 0.05), hematocrit in lowest core temperature (P > 0.05) and the velocity of rewarming. Mean circulatory arrest time in ASCP group was significant longer than in DHCA group (P < 0.05). There were much more patients with jugular arteries impaired or companying with related cerebrovascular diseases in group ASCP compared to group DHCA. The baseline of S100beta in CSF before cardiopulmonary bypass was no difference. S100beta value in CSF ascended to peak level in 12 h after the operation, showing significantly higher in group DHCA than in group ASCP DHCA vs. ASCP, (0.90 +/- 0.11) microg/ml vs. (0.61 +/- 0.26) pg/ml]. In most hours after operation there was significant intergroup difference. IL-6 value in CSF ascended to peak level in 12 h postoperative for group DHCA and 0 h postoperative for group ASCP. There was no significance difference observed in IL-6 of CSF between two groups except 6 h and 12 h postoperative. CONCLUSIONS: Brain ischemic injury occurred during aortic operations assisted by brain protective methods is not serious. Unilateral ASCP which can delivery adequate oxygen to brain during circulation arrest has some advantage of alleviating ischemic injury compared with only DHCA.