心脏不停跳心内直视手术对血浆NSE和S-100b及脑电图的影响

目的　比较心脏不停跳与心脏停跳心内直视手术患者 ,围手术期血浆中神经元特异性烯醇化酶 (NSE)与S 10 0b蛋白的含量及脑电图的变化 ,探讨它们造成脑损伤的差异。方法　 40例接受心内直视手术患者 ,随机分为A组 (n =2 0 ) ,在心脏停跳下施行手术 ;B组 (n =2 0 ) ,在心脏不停跳下施行手术 ;两组先天性心脏病和风湿性心脏病各 10例。全组均在术前、CPB开始后 2 0min、CPB结束后 1h和 2 4h采取血样本 ,运用酶联免疫吸附法测定血浆中NSE和S 10 0b蛋白含量 ;结合患者术前与术后 7d的脑电图检查 ,评价两种方法造成脑组织损伤的差异。结果　CPB开始 2 0min两组患者血浆中的S 10 0b均明显升高 (P <0 .0 1) ,而且一直持续到CPB后 2 4h仍高于术前水平 (P <0 .0 1) ;CPB开始 2 0min ,A组中先心病患者血浆S 10 0b升高程度高于B组中先心病患者 (P <0 .0 5 )。在CPB开始 2 0minA组患者血浆NSE升高的程度高于B组患者 (P <0 .0 5 ) ;血浆NSE水平在CPB开始 2 0min先心病组明显升高 (P <0 .0 1) ,一直持续至CPB结束后 1h达到最高点 ,至CPB后 2 4h降至术前水平 (P >0 .0 5 ) ;风心病组患者在CPB开始 2 0minNSE升高 (P <0 .0 5 ) ,在CPB后 1h明显升高 ,一直持续到CPB后 2 4h仍较术前高 (P <0 .0 1)。术后两组患者EEG结果较术

Effect of beating heart intracardiac procedures on the changes of plasma NSE, S-100b and EEG

Objective To explore the differences in cerebral injury procedure by the changes perioperative neuron specific enolase (NSE), S 100b and EEG caused by (beating heart or arrested heart). Methods Forty patients were randomly divided into two groups: control group(group A, n =20) and experimental group(group B, n =20). There were 10 cases of congenital heart disease and 10 cases of rheumatic heart disease in each group. Patients in group A underwent arrested heart intracardiac procedures while those in group B underwent beating heart procedures. Blood samples were collected before operation, at 20 min after the start of cardiopulmonary bypass (CPB), 1 h after the end of CPB and 24 h after CPB. Levels of plasma NSE and protein S 100b were measured by ELISA. All patients were examined with EEG before and 1 week after operation. The differences due to the two surgical procedures were assessed. Results The level of plasma protein S 100b increased significantly at 20 min after the start of CPB and remained at high level till 24 h after CBP( P <0.01). Plasma NSE level in congenital heart disease group increased more significantly than that in rheumatic heart disease group at 20 min after the start of CPB and returned to the nadir at 24 h after CPB, but it was still higher than the preoperative level in rheumatic heart disease group at the same time( P <0.01). Plasma NSE level in group A was significantly higher than that in group B at 20 min after the start of CPB. The protein S 100b of the patients with congenital heart disease in group A was significantly higher than that in group B at 20 min after the start of CPB ( P <0 05). The postoperative EEG abnormality rates were 65% in group A and 70% in group B, respectively. There was no significant difference between the two groups. Conclusion The on pump beating heart intracardiac procedures do not result in more serious cerebral dysfunction than the traditional arrested heart intracardiac procedures.