髓鞘碱性蛋白评价CPB心脏手术患者脑损伤的准确性

Accuracy of myeline base protein in evaluation of brain injury in patients undergoing cardiac surgery performed under CPB

目的 探讨髓鞘碱性蛋白（MBP）评价CPB心脏手术患者脑损伤的准确性.方法 拟行CPB辅助下冠状动脉旁路移植术的患者32例,性别不限,年龄59～76岁,体重52～72 kg,身高150～175 cm,ASA分级Ⅱ～Ⅳ级,美国国立卫生研究院卒中量表评分（NIHSS评分）≤9分.分别于CPB前（T0）、CPB 30 mim（T1）、结束即刻（T2）、结束后1 h（T3）、6 h（T4）、24 h（T5）时取颈内静脉血样,测定血浆MBP浓度,记录手术时间、CPB时间、主动脉阻断时间.术后第2天行NIHSS评分,根据评分结果将患者分为3组,A组：无明显神经功能损伤,NIHSS评分0～9分;B组：轻度神经功能损伤,NIHSS评分10～19分;C组：中、重度神经功能损伤,NIHSS评分20～45分.结果 与正常上限值（2.3μg/L）比较,A组Tl～T3、T5时血浆MBP浓度降低（P＜0.01）,T4时差异无统计学意义（P＞0.05）,B组T3～T5时、C组T2～T5时血浆MBP浓度升高（P＜0.01）.与T4时比较,T0～T3时B组和C组血浆MBP浓度降低,T5时B组降低,C组升高（P＜0.01）;与A组比较,B组T3～T5时、C组T1～T5时血浆MBP浓度升高（P＜0.01）;与B组比较,C组T1～T5时血浆MBP浓度升高（P＜0.01）;T5时血浆MBP浓度与CPB时间呈正相关（相关系数为0.62,P＜0.05）,T1、T2和T5时血浆MBP浓度与NIHSS评分呈正相关（相关系数分别为0.70、0.79、0.87,P＜0.05）.结论 血液MBP可及早、准确地判断CPB心脏手术患者的脑损伤及其程度.

Objective To investigate the accuracy of myeline base protein （MBP） in evaluation of brain injury in patients undergoing cardiac surgery performed under CPB. Methods Thirty-two ASA Ⅱ- Ⅳ patients of both sexes （20 males, 12 females） aged 59-76 yr weighing 52-72 kg undergoing coronary artery bypass grafting （CABG） under CPB were studied. Patients with history of neurological disease were excluded. Preoperative National Institute of Health stroke scale （NIHSS） score ≤ 9. According to postoperative NIHSS score on 2nd postoperative day, the patients were divided into 3 groups： group A no neurological deficit （ NIHSS score 0-9 ）;group B mild neurological deficit （NIHSS score 10-19） and group C moderate or severe neurological deficit （NIHSS score 20-45）. Blood samples were taken from internal jugular vein before CPB （T0）, at 30 min of CPB （T1）, at the discontinuation of CPB （T2）, and at 1, 6, 24 h after discontinuation of CPB （T3-5） for determination of the plasma MBP concentration. The duration of operation, CPB time, aortic cross-clamping time were recorded.Results In group B the plasma MBP level peaked at 6 h after CPB （T4） and then decreased rapidly while in group C the plasma MBP level exceeded the normal upper limit at T2 and kept increasing till 24 h after CPB （T5 ）.The plasma MBP level decreased at T1-3.5 in group A as compared with the normal upper limit. The plasma MBPlevel was significantly higher at T3-5 in group B and at T1-5 in group C than in group A and at T1-5 in group C than in group B. Linear regression analysis indicated that there was positive correlation between plasma MBP level and CPB time at T5. NIHSS scores were positively correlated with plasma MBP level at T1 , T2, and T5. Conclusion MBP can early reflect the severity of brain injury in patients undergoing cardiac surgery under CPB.