单侧与双侧顺行性脑灌注对深低温停循环病人血浆S-100β和NSE浓度的不同影响

Different Effects of Unilateral/Bilateral Cerebral Perfusion on Serum S-100 Beta and Neuron Specific Enolase Levels in Patients at Deep Hypothermia Circulatory Arrest

目的:通过观察血清神经组织蛋白S-100β和神经元特异性烯醇化酶(NSE)浓度变化,比较单侧与双侧顺行性脑灌注在深低温停循环手术中的脑保护效果,旨在探求一种更好的脑保护方式。方法:60例深低温停循环手术病人随机分成单侧组和双侧组,每组30例。于体外循环开始时(T1)、停循环时(T2)、脑灌注25min时(T3)、脑灌注结束时(T4)、体外循环结束时(T5),以及术后1h(T6)、6h(T7)、24h(T8)时抽取右侧颈静脉球部血液,采用双抗体夹心(ELISA)法测定血清中S-100β蛋白和NSE浓度。结果:T1,T2,T3时间点两组间S-100β和NSE浓度无统计学差异,T4,T5,T6,T7,T8时间点均有统计学差异。结论:深低温停循环手术中,停循环25min内,单、双侧顺行脑灌注效果相当,但超过25min,双侧顺行脑灌注脑保护效果更佳。

Objective：To study the different effects of unilateral and bilateral antegrade cerebral perfu-sion（ACP）during deep hypothermia circulatory arrest（DHCA）surgery,through observing the changes of serum S-100β and neuron specific enolase（NSE）concentration,then to determine which is the optimal method of brain protection.Methods：Sixty patients underwent aortic arch surgery were randomized into either unilateral cerebral perfusion with a cannula in the innominate artery（n=30）,or bilateral cerebral perfusion with an additional cannula in the left carotid artery （n=30）.S-100β and NSE levels were assayed at the beginning of cardiopulmonary bypass（T1）, the beginning of circulatory arrest（T2）,ACP for 30min（T3）,the end of ACP（T4）,the end of cardiopulmonary bypass（T5）,and 1h（T6）,6h（T7）and 24h（T8）post-operation.Results：No statistical differences of S-100β and NSE serum levels were found between the two methods at each time point of T1,T2,and T3.While at T4,T5,T6,T7,and T8time points,serum levels of S-100β and NSE were lower in bilateral ACP group than in unilateral ACP group.Conclusion：There is no significant difference between unilateral ACP and bilateral ACP in 25min during DH-CA.But as the DHCA time extends,the effect of bilateral ACP might be better.