机械通气对肺性脑病患者血清神经元特异性烯醇化酶的影响

Serum Level of Neuron-Specific Enolase and Its Changes after Treatment with Mechanical Ventilation in Patients with Pulmonary Encephalopathy

目的观察机械通气治疗对肺性脑病患者血清神经元特异性烯醇化酶(NSE)的影响。方法 21例肺性脑病患者机械通气前、机械通气12h后及患者意识转清时记录其格拉斯哥昏迷评分(GCS),同时抽取外周静脉血和动脉血,放射免疫法检测血清NSE,动脉血气分析检测PaCO2和PaO2。结果 21例肺性脑病患者在机械通气12h后血清NSE较械通气前显著降低[(24.54±6.65)μg/L比(28.39±4.85)μg/L,P<0.05],GCS评分较机械通气前显著升高[(12.00±2.10)分比(9.67±1.28)分,P<0.01],PaCO2和PaO2较机械通气前均有显著改善(P<0.01)。经治疗后意识转清18例,未转清3例。18例患者意识转清时GCS评分较机械通气前好转[(12.67±1.53)分,P<0.01],血清NSE水平进一步降低[(14.19±2.91)μg/L,P<0.01]。结论血清NSE检测反映机械通气治疗后患者脑功能的改善,可作为判断预后的指标。

Objective To observe the serum level of neuron-specific enolase（NSE） in patients with pulmonary encephalopathy and its changes after treatment with mechanical ventilation.Methods Twenty-one patients with pulmonary encephalopathy were enrolled.Glasgow coma scale（GCS）,serum NSE level,and arterial blood gas were evaluated at three time-points：before mechanical ventilation,after 12 hours mechanical ventilation,and the moment of consciousness.Results 18 patients recovered consciousness,and 3 patients remained in persistent coma and died.GCS and arterial blood gas improved obviously after 12 hours mechanical ventilation.Meanwhile,the serum NSE concentration decreased significantly after 12 hours mechanical ventilation [（24.54±6.65）μg/L] and at the moment of consciousness [（14.19±2.91）μg/L] compared with before mechanical ventilation（P0.05,P0.01）.Conclusion Dynamic measurment of serum NSE may be a useful biomarker for assessing the severity of cerebral injury and predicting prognosis.