不同策略冠状动脉旁路移植术血浆S100β蛋白的变化及意义

The Change and Meaning of Serum S100β Protein During CABG With or Without Extracorporeal Circulation

目的本研究的目的是通过测定血浆S100β的浓度变化监测传统的体外循环下冠状动脉旁路移植术(CCABG)和非体外循环下冠状动脉旁路移植术(OPCABG)过程中脑损伤的情况。方法选择35例OPCABG和25例CCABG手术患者进行了前瞻性的研究,在不同时间点采集血液标本测定血浆S100β的浓度,评价麻醉及手术的不同时期脑损伤情况。结果两组血浆S100β在麻醉诱导前处于最低水平,在心脏操作前就显著升高(P<0.05),在关胸前峰值水平最高且CCABG组高于OPCABG组(P<0.05),术后24h两组均明显下降,但均高于基线水平(P<0.05)。结论研究表明脑损伤可能在心脏操作前即已经发生,提示我们在整个麻醉和心脏手术的全过程中都要注重脑保护。

OBJECTIVE To detect the brain damage state by observing the changes of the serum S100 β protein levels during conventional coronary artery bypass graft （CCABG） and off - pump coronary artery bypass graft （OPCABG）. METHODS 60 patients, 35 for OPCABG and 25 for CCABG, were studied. Patients＇blood samples were taken before anesthesia during operation and postoperation, to measure the lenels of serum S100 β protein. RESULTS Both groups＇ serum S100 β protein levels were the lowest before induction of anesthesia and significantly increased, before heart operating（ P 〈0.05）. CCABG group＇peak values was higheer than OPCABG group （ P 〈0.05）. Both groups＇serum S100 β protein levels declined significantly in the first postoperative 24 hours, but didn＇t recover to the levels of before anesthesia （ P 〈 0.05 ）. CONCLUSION This study has shown that brain damage had occurrenced before manipulation of the heart. These findings may have implications that brain protection should be emphasized during the course of anaesthesia care and cardiac surgery.