心脏不停跳心内直视手术与神经元损伤

Beating open-heart surgery and neuronal injury

目的 对比观察心脏不停跳与传统的心内直视手术对神经元的损伤情况。方法 1 0 3例体外循环 (CPB)心内直视手术病人随机分为两组 :心脏不停跳组 (试验组 ) 51例 ,术中不阻断升主动脉 ,CPB中鼻咽温度为 32～ 34℃ ;心脏停跳组 (对照组 ) 52例 ,术中阻断升主动脉 ,CPB中鼻咽温度为 2 5～2 7℃。动态监测围术期所有病人颈内静脉血中S 1 0 0 β蛋白和神经元特异性烯醇酶 (NSE)的水平变化。结果 两组术中及术后早期 ,S 1 0 0 β蛋白和NSE水平明显高于术前 (P <0 0 5或P <0 0 1 ) ,其中S 1 0 0 β蛋白术后 3d恢复至术前水平 ,NSE术后 1d恢复至术前水平 ;试验组S 1 0 0 β蛋白从转流 2 0min到术后 1d明显低于对照组 (P <0 0 5或P <0 0 1 ) ,NSE从转流毕到术后 8h明显低于对照组 (P <0 0 5或P <0 0 1 ) ;试验组术后出现精神异常 1例 ,对照组术后出现偏瘫 2例。结论 颈内静脉血中S 1 0 0 β蛋白和NSE的水平变化 ,尤其是前者可作为评价心内直视手术对神经元损伤程度的可靠指标 ;心脏不停跳心内直视手术对神经元的损伤比传统的手术方式轻。

Objective: To compare the effect of beating and static open heart surgery on neuronal injury. Methods: 103 cases open heart surgery under cardiopulmonary bypass (CPB) patients were divided into beating heart group (n=51) and static heart group (n=52). The parameters of protein S 100β and neuron specific enolase (NSE) in jugular vein were measured during the perioperative period. Results: The changes of two parameters in the both groups during and after operation were significantly higher than that before operation (P<0 05 or P<0 01). The level of the protein S 100β in beating heart group were significantly lower than that in control group, from 20 minutes after CPB to 1st postoperative day. The NSE was significantly lower in beating heart group than that in control group immediately after CPB and maintain to 8 hours postoperatively. Conclusion: The analysis of protein S 100β and NSE may provide a valuable tool to monitor and evaluate neuronal injury after cardiac surgery. The neuropsychiatric deficits in neuronal injury may be lighter in beating open heart surgery.