体外循环术中血糖浓度对术后脑损伤的影响

Influence of intraoperative blood glucose concentration on brain damage induced by cardiopulmonary bypass

目的:体外循环术中血糖浓度对术后脑损伤的影响。方法:选择体外循环心脏手术患者82例,根据术中最高血糖值:<11.1mmol/L患者为正常组,≥11.1mmol/L为升高组。计算术(麻醉)前、术毕复温后脑氧摄取率(CERO2);检测术前及术后血清乳酸(Lac)、S-100β蛋白(S100β)及特异性神经原烯醇化酶(NSE)的含量;术前1d和术后72h行简易智力状态检查(MMSE)评分。结果:37例为正常组,45例为升高组,术前两组CERO2、Lac、S100β、NSE与MMSE评分比较,差异均无统计学意义(P>0.05),术后除了MMSE评分下降外,CERO2、Lac、S100β与NSE表达均上升,但升高组的术后CERO2、Lac、S100β、NSE明显高于正常组,MMSE评分低于正常组,差异具有统计学意义(P<0.05)。结论:体外循环术中高血糖加剧术后乳酸的堆积,影响脑氧摄取率,加重脑神经损伤,降低患者的认知功能。

Objective： To explore the influences of intraoperative blood glucose concentration on brain damage induced by cardiopulmonary bypass. Methods： A total of 82 patients undergoing cardiac surgery were divided into normal group （blood glucose concentration （11.1 mmol/L） and elevated group （blood glucose concentration≥11.1 mmol/L） according to the highest intraoperative blood glucose concentration. Cerebral oxygen extraction rates （CERO2） were calculated before anesthesia and being rewarmed after the operation. Preoperative and postoperative serum lactic acid （Lac）, S - 100β protein （S100β） and neuron specificity enolization enzyme （NSE） were detected. Mini Mental State Examination （MMSE） was carried out 1 day before and 72 h after surgery. Results： The normal group included 37 cases and elevated group included 45 cases. No significant difference in CERO2, Lac, S100β, NSE and MMSE were observed between the two groups before undergoing the operation, but CERO2, Lac, S100β, NSE were significant higher in the elevated group than that in the normal group （P〉0.05）. After undergoing the operation, MMSE score of the elevated group was significant lower than that in the normal group （P〈0.05）. Conclusions： Hyperglycemia during cardiopulmonary bypass increase the accumulation of lactic acid after operation, affect the cerebral oxygen extraction rate, increase severity of brain damage, and decrease the patients cognitive function.