吗啡预处理对心脏手术患者血清S-100β蛋白和神经元特异性烯醇化酶水平的影响

Effects of morphine preconditioning on levels of S-100β protein and neuron-specific enolase in the serum in patients undergoing cardiac operations

目的观察在心脏手术中吗啡预处理对患者血中S-100β蛋白和神经元特异性烯醇化酶(NSE)的影响。方法选择择期心脏手术的成年患者16例,随机分为吗啡预处理组和对照组。常规诱导和气管插管,持续泵入丙泊酚和吸入七氟醚维持麻醉,间断追加芬太尼和哌库溴铵。吗啡预处理组在开胸后给予吗啡0.2mg/kg。分别在诱导后、体外循环(CPB)开始后30min、CPB结束时、手术结束时以及手术后6h经中心静脉抽血测定S-100β蛋白和NSE水平。结果两组患者血清S-100β蛋白水平在CPB开始后30min显著升高,在CPB结束时最高,此后逐渐下降。在CPB结束时吗啡预处理组S-100β蛋白水平显著低于对照组。在CPB结束时对照组NSE升高显著,而吗啡预处理组无显著改变。两组NSE水平在手术结束时均高于诱导后水平。结论心脏手术中CPB后S-100β蛋白和NSE水平均显著升高,提示存在脑损伤的可能性。S-100β蛋白似较NSE更敏感。吗啡预处理显著降低了S-100β蛋白的水平,表明吗啡预处理可能有一定的脑保护作用。

Objective To observe the changes of levels of S-100β protein and neuron-specific enolase（NSE） in the serum in patients undergoing cardiac surgery by morphine preconditioning from CPB in some degree.Methods Sixteen adult patients were randomly divided into morphine preconditioning group （M group） and control group（C group）.After conventional anesthesia induction and tracheal intubation,continuous infusion of propofol and sevoflurane inhalation were used to maintain anesthesia.Additional fentanyl and pipecuronium were intermittently added if they were needed.Morphine preconditioning group was given morphine 0.2 mg/kg after thoracotomy.At the time of after induction （T1）,30 min after the CPB （T2）,the end of CPB （T3）,the end of surgery （T4） and the six hours after surgery （T5）,4 ml blood samples were respectively drew from the central line and ELISA assay was used to determine the S-100β protein and NSE levels.Results S-100β protein levels were significantly higher at 30 min after the beginning of the cardiopulmonary bypass （CPB）,and the highest level occurred at the end of CPB,then they were gradually decreased in two groups.At the end of CPB,the S-100β protein levels of M group were significantly lower than that of the C group,and the NSE levels of C group significantly increased,but M group had no significant changed.At the end of the surgery,the levels of NSE were higher than that of the time after conduction in the two groups.Conclusions After cardiopulmonary bypass in cardiac surgery,the levels of S-100β protein and NSE were significantly increased,suggesting the possibility of brain damage occurred.S-100β protein level is more sensitive than that of NSE for detecting the brain damage.Morphine preconditioning may significantly reduce the levels of S-100β protein,indicating that morphine preconditioning may protect the brain damage.