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目的探讨婴幼儿先天性心脏病体外循环(CPB)术后血清S100B蛋白动态变化的临床价值。方法随机选择2005-01—2005-06在山东大学齐鲁医院心脏外科住院的先天性心脏病患儿32例(年龄1-3岁),分别在手术前及体外循环结束后2h、5h、12h、24h、48h和7d抽血,采用ELISA法定量检测血清S100B的水平,进行统计学分析和描述。结果在CPB结束后血清S100B的水平先上升[从CPB结束后2-5h,由(2.13±0.67)μg/L升至(2.97±0.82)μg/L,P<0.01],再迅速下降[CPB结束后5-12h,由(2.97±0.82)μg/L降至(1.07±0.26)μg/L,P<0.01],然后平稳下降[在之后的1-7d内,由(0.87±0.21)μg/L降至(0.14±0.11)μg/L,P<0.01]。在CPB结束后7d[(0.14±0.11)μg/L]仍稍高于术前水平[(0.08±0.04)μg/L](P<0.01)),恢复至术前水平者占53.1%(17/32)。结论婴幼儿体外循环术后脑损伤主要是由于体外循环本身所造成的,术后脑损伤部分为可逆性的。动态观察S100B的水平变化,对预测婴幼儿患者体外循环术后脑损伤的发展趋势、评价治疗效果等具有重要的临床价值。

Clinical value of the change of serum levels of S100B after open heart surgery of infant patients by cardiopulmonary bypass

??AbstractObjectiveTo study on clinical value of the change of the blood serum levels of S100B after open heart surgery of infant patients by cardiopulmonary bypass(CPB).MethodsThirty??two patients with congenital heart disease(CHD) were selected randomly.Before the operation of heart,at 2 hours,5 hours,12 hours,24 hours,48 hours and 7 days after CPB,whole blood was taken,and the blood serum levels of S100B were assayed by enzyme??linked immunosorbent assay(ELISA) method.Data were analysed by statistics method.ResultsSerum level of S100B increased quickly[(2.13??0.67)??g/L to (2.97??0.82)??g/L,from 2 hours to 5 hours after CPB??P<0.01],then decreased quickly[(2.97??0.82)??g/L to (1.07??0.26)??g/L,from 5 hours to 12 hours after CPB??P<0.01],then decreased steadily[(0.87??0.21)??g/L to (0.14??0.11)??g/L,from 1 day to 7 days after CPB??P<0.01].It was slightly higher than the preoperative level[(0.14??0.11)??g/L vs(0.08??0.04)??g/L??P<0.01] at 7days after CPB and patients whose levels of S100B returned to the preoperative level were 53.1%(17/32).ConclusionBrain injuries of patients with CHD after CPB are mostly caused by CPB itself,being reversible mostly.Detecting the change of serum level of S100B has important clinical significance in predicting the progress of brain injuries and assessing therapeutic efficacy of patients with CHD after CPB.