血清S100β及NSE含量与心肺转流心脏瓣膜置换术后早期认知功能障碍的相关性研究

Correlation between postoperative cognitive dysfunction and serum level of S100βand NSE in on-pump heart valve replacement

目的探讨血清S100β及神经元特异性烯醇化酶(NSE)的含量变化与心脏瓣膜置换术后早期认知功能障碍(POCD)的相关性。方法择期行心脏瓣膜置换术的患者98例,分别于术前1d、术后1d采用简易智力量表(MMSE)进行神经功能测试,以术后评分下降大于或等于术前评分的一个标准差评定为POCD,根据评分结果,将患者分为POCD组(P组)及非POCD组(NP组)。分别于麻醉诱导前(T0)、手术结束时(T1)、术后24h(T2)、术后48h(T3)抽取动脉血检测S100β和NSE的含量。结果术后1dPOCD的发生率为45例(45.9%)。与T0时比较,T1时两组S100β蛋白明显升高(P<0.05);T1、T2时两组NSE含量明显升高,T3时NP组仍明显升高(P<0.05);两组组间差异无统计学意义。患者清醒时间延长(OR=1.222,P=0.004)及术后即刻S100β含量升高(OR=1.85,P=0.009)为术后1d发生POCD的危险因素。结论心脏术后存在较高的认知功能障碍发生率,清醒时间延长及术后即刻S100β含量的升高是术后1d发生POCD的危险因素。

Objective To explore the correlation between postoperative cognitive dysfunction （POCD）and serum level of S100βand NSE in patients undergoing on-pump heart valve replacement. Methods Ninety-eight patients underwent elective heart valve replacement were enrolled and divided into two groups：POCD group （group P）and none POCD group（group NP）by the result of neurocog-nitive testing with MMSE performed preoperatively and on the first postoperative day.Serum S-100βprotein and NSE were measured before operation（T0 ）,at the end of operation（T1 ）,24 h（T2 ）and 48 h（T3 ） postoperatively.Results The incidence of POCD on the first postoperative day was 45 （45.9%）.Compared with T0 ,the S100βincreased at T1 in both groups （P 〈0.05）,NSE increased at T1 and T2 in both groups,and NSE increased in group NP at T3 （P 〈0.05）.There was no signifi-cant difference of NSE between groups P and NP.The prolonged recovery time（OR = 1.222,P =0.004）and increased concentration of S100βat the end of operation（OR=1.85,P =0.009）were pre-dictors of POCD on the first postoperative day.Conclusion There was a higher incidence of POCD af-ter on-pump heart valve replacement surgery.The prolonged recovery time and increased concentra-tion of S100βat the end of operation might be predictors of POCD.