神经元特异性烯醇化酶对心肺复苏后缺血缺氧性脑病的临床意义

Clinical significance of neuron specific enolase in the patients with hypoxic - ischemic eneephalopathy after cardio - pulmonary resuscitation

目的探讨神经元特异性烯醇化酶（NSE）用于早期评价心肺复苏（CPR）术后发生缺血缺氧性脑病的严重程度及预后判断的可行性。方法2009—05-2011—06吉林大学第二医院急救医学科收治的CPR术后恢复自主循环并处于昏迷状态需进一步高级生命支持的患者25例。在患者人院后的24h内留取标本行NSE、动脉血乳酸水平的测定，并进行格拉斯哥昏迷评分（GCS），动态监测NSE水平变化。对入选病例进行随访（期限为3个月），并行格拉斯哥预后评分（GOS），按照评分标准分为A组（死亡、植物状态、意识转清生活不能自理）和B组（生活能自理、正常生活但有轻度神经障碍）。利用SPSS7．0软件对结果进行统计学分析。结果A组患者人院时GCS评分低于B组，但动脉血乳酸、血NSE水平均高于B组患者，两组比较差异有统计学意义。动态监测NSE水平，NSE水平高峰值约在CPR后48h出现。结论NSE可以作为评价CPR术后缺血缺氧性脑病的早期指标。NSE与GCS评分、血乳酸等指标均可反映缺血缺氧性脑病的严重程度及判断预后。NSE水平越高，脑损伤程度越重，预后越差。

Objective To investigate the feasibility of neuron specific enolase （NSE） used for evaluating the severity and prognosis of the patients with hypoxic - ischemic encephalopathy after cardio -pulmonary resuscitation （CPR）. Methods The clinical data of 25 patients with restoration of spontaneous circulation in a coma need further advanced life support after CPR was collected from May 2009 to June 2011 in ICU of our hospital. Specimens were taken for NSE, arterial blood lactate concentration and the Glasgow coma score when the patients were admitted within 24 h, and the changes of NSE levels were monitored. Selected cases were followed up for a period of 3 months. According to GOS standards, the patients were divided into group A （death, vegetative state, turned clear consciousness but can not take care of themselves） and group B （live independently, normal life but with mild neurological disorders）. The results were analyzed with SPSS7.0 statistical software. Results The GCS score was lower in group A patients than in group B patients, but the arterial blood lactate and NSE levels were higher than in group B patients, the difference between the two groups was statistically significant （ P 〈 0. 05 ）. According to dynamic monitoring of NSE levels, NSE peak concentration appeared at about 48 hours after CPR. Conclusion NSE can be used as an early indicators for the evaluation of hypoxic - ischemic encephalopathy alter CPR. NSE and GCS score, arterial blood lactate can reflect the severity and prognosis of hypoxic - ischemic encephalopathy. The higher of NSE levels show the brain damage is more severe, and the prognosis is worse.