地塞米松对体外循环心瓣膜置换术患者血S-100β和神经元特异性烯醇化酶的影响

Effects of dexamethasone on blood S-100βand Neuron Specific Enolase levels in cardiac valve replacement patients undergoing cardiopulmonary bypass

目的:探讨地塞米松对体外循环下心脏瓣膜置换术患者血S-100β和神经元特异性烯醇化酶(NSE)的影响及其机制。方法:择期体外循环下心脏瓣膜置换术病人30例,年龄31～63岁,体重46～76 kg,ASAⅡ或Ⅲ级,随机分为地塞米松组和对照组。地塞米松组于手术开始前1 h静注地塞米松0.5 mg/kg,对照组静注等量生理盐水。在静注地塞米松前(T_1)、体外循环开始(转机)即刻(T_2)、体外循环结束时(T_3)、手术结束时(T_4)、术后24 h(T_5)、术后48 h(T_6)采集静脉血(T_1取自外周静脉,T_2～T_6取自颈内静脉置管),采用ELISA法测定TNF-α、IL-1β及脑损伤标志物S-100β蛋白和NSE的浓度。结果:两组病人IL-1β、TNF-α浓度在T_2～T_5均高于T_1(P<0.05),且地塞米松组低于对照组(P<0.05),T_6恢复至T_1水平。两组病人NSE浓度在T_3～T_6时明显高于T_1～T_2(P<0.05),且T_3～T_5时地塞米松低于对照组(P<0.05)。两组病人S- 100β蛋白浓度在T_3～T_5时高于T_1～T_2(P<0.05),T_6时基本恢复至T_1水平,且在T_3～T_4时地塞米松低于对照组(P<0.05)。结论:地塞米松能降低心脏瓣膜置换术病人血S-100β和NSE的水平,其脑保护机制与减少促炎细胞因子释放有关。

AIM： To observe the effects of dexamethasone （DXM） on blood S-100β and Neuron Specific Enolase（NSE） levels of cardiac valve replacement patients undergoing cardiopulmonary bypass （ CPB ）. METHODS： 30 patients, who were 31 - 63 years old, weighted 46 - 76 kg, ASA Ⅱ - Ⅲ, were randomized to received 0.5 mg/kg dexamethasone （ dexamethasone group） or placebo（ control group） 60 minutes before operation. The plasma levels of TNF-α, IL-1β, S-100β and NSE were measured at the following times： before the dexamethasone or placebo were administered（ T1 ）, before starting CPB（ T2 ）, the end of CPB（ T3 ）, immediately after operation（T4）, 24 h after skin closure（T5 ） and 48 h after skin closure（ T6 ）. RESULTS： Both the plasma concentrations of TNF-α, IL-1β were upregulated after T2. S-100β and NSE were upregulated after T3 （ P 〈 0.05） and almostly resume to normal level at T6. The plasma concentrationS of TNF-α, IL-1β, S-100β and NSE in dexamethasone group were lower than those in placebo group （P 〈 0.05 ）. CONCLUSION： Dexamethasone may decrease the blood S-100β and NSE levels after cardiopulmonary bypass by inhibitting the release of proinflammatory cytokine.