体外与非体外循环冠状动脉旁路移植术的脑损伤

Brain Injuries in Patients during Cornonary Artery Bypass Graft with or without Cardiopulmonary Bypass

目的:通过测定血浆S100B蛋白水平,对比体外循环下冠状动脉旁路移植术(CCABG)与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:2006年7月-2007年8月本院冠状动脉搭桥患者18例,其中CCABG组10例,OPCABG组8例。于麻醉诱导前(T1)、主动脉侧壁钳开放时(T2)、手术结束时(T3)、术后24h(T4)采血测血浆S100B蛋白浓度,评价手术不同时期脑损伤情况。结果:两组患者在T1、T4时血浆S100B蛋白浓度差异无统计学意义,CCABG组患者在T2及T3时血浆S100B蛋白浓度(2.77±0.69,2.83±0.79)μg/L较OPCABG组(0.89±0.71,0.91±0.63)μg/L显著升高(P<0.05)。结论:非体外循环冠脉搭桥术由于避免了体外循环,从而降低了术后脑损害的风险。

Objective： To investigate the brain damage as reflected by changes of the serum S100B protein levels during conventional coronary artery bypass graft （CCABG） and off-pump coronary artery bypass graft （OPCABG）. Methods： Between July 2006 and August 2007, 18 patients who underwent coronary bypass were studied, including 8 cases of OPCABG and 10 eases of CCABG. Blood samples from jugular vein were phlebotomized in every patient before induction of anesthesia （T1）, at the end of grafting （T2）, at the end of operation （T3） and 24 h after operation （T4）, for measurement of serum concentrations of S100B protein. Results： Serum S100B protein levels were not significantly different at time spots T1 and T4 between the two groups, but were markedly elevated at time spots T2 and T3 in CCABG group as compared with OPCABG group [（2.77±0.69） μg/L and （2.83±0.79） μg/L vs （0.89±0.71） μg/L and （0.91±0.63） μg/L] （P 〈 0.05）. Conclusion： Avoidance of extracorporeal artery bypass in OPCABG can result in lower risk of postoperative brain damage.