冠状动脉搭桥术患者围术期血浆神经元特异性烯醇化酶浓度与术后认知功能

Perioperative plasma concentrations of neuron-specific enolase and postoperative cognitive function in patients undergoing coronary artery bypass grafting surgery

目的研究冠状动脉搭桥术患者围术期血浆神经元特异性烯醇化酶 (NSE) 浓度及术后认知功能.方法 40例接受冠状动脉搭桥术的男性患者,分为体外循环组和非体外循环组,每组20例.在术前、术后6、12、18和24 h采血,用放射免疫方法测定血浆NSE浓度.在术前1天和术后7～10天进行神经心理测试.结果体外循环组患者术后6 h血浆NSE浓度比术前显著升高,同时高于非体外循环组;非体外循环组患者各时点无差别.非体外循环组患者在数字广度测验(逆向)、斯特鲁字色干扰测验改正反应和阻塞反应的结果显著优于体外循环组患者.体外循环组患者术后6 h NSE水平与连线测验A型相关,术后12 h NSE浓度与数字广度测验(顺向)、连线测验A型、斯特鲁字色干扰测验时间分项相关.结论心脏手术后血浆NSE浓度的升高可在某种程度上反映术后认知功能障碍,但在具体应用时应考虑NSE的组织多源性及体外循环因素的影响.

Objective To investigate perioperative plasma concentrations of neuron-specific enolase （NSE） and cognitive function in patients undergoing coronary artery bypass grafting （CABG） surgery. Methods Fourty male patientsated into CP scheduled for elective coronary artery bypass grafting were allocB group （n = 20） or off-pump group （n = 20）. Blood samples were collected before and 6, 12, 18 and 24 h after surgery. Plasma NSE was determined by radioimmunoassay. The neuropsychological tests were performed before and 7 to 10 days after surgery. Results In CPB group, the concentration of NSE at 6 h after surgery was significantly higher than that of baseline and that in off-pump group, while there was no differences among the concentrations of NSE in off-pump group. The Digit Span subtest of the WAIS-R （backward）, the Stroop colour word interference test （correction and obstruction responses） in the off-pump group were significantly better than those in the CPB group. In the CPB group, the NSE value at the 6 h after surgery was correlated with the Trail Making Test, while the concentration of NSE at 12 h was correlated with the Digit Span Test （Forward）, the Trail Making Test and the Stroop Colour Test. Conclusion The elevation of postoperative plasma concentration of NSE may, to some extent, reflect postoperative cognitive dysfunction. However, the existence of NSE in multiple tissues and the impact of CPB should be taken into consideration while plasma NSE is used in this situation.