神经元烯醇化酶对以脑氧导向双侧脑灌注弓部手术后神经系统并发症的预测

Serum neuron-specific enolase level could predict neurological complications af ter aortic arch surgery with cerebral oxygenation-oriented bilateral antegrade cerebral perfusion

目的探究血清神经元烯醇化酶(NSE)对以脑氧为导向的双侧脑灌注弓部手术神经系统并发症的预测价值。方法本研究纳入了2018年12月至2019年12月25例[年龄(49.8±12.0)岁;男性20(80%)]弓部手术患者,以脑氧为导向、双侧脑灌注为脑保护策略,根据术后有无神经系统并发症[包括暂时性神经功能障碍(TND)和永久性神经功能障碍(PND)]分为两组,无神经系统并发症组(n=19)和有神经系统并发症组(n=6),比较两组术前和术后0 h、6 h、24 h血清NSE水平,并用不同时段血清NSE水平对术后神经系统并发症进行预测。结果两组基础脑氧与术中单独脑灌注脑氧无统计学差异(P>0.05),术后6例(24%)患者出现神经系统并发症(TND=5;PND=1)。术后0 h、6 h、24 h血清NSE均高于无神经系统并发症组(P<0.05),受试者操作特征曲线分析提示术后24 h血清NSE>29.65 ng/ml提示神经系统损伤,敏感度为0.833,特异度为0.789,曲线下面积0.851(95%CI 0.693~1.000)。结论以脑氧为导向、双侧脑灌注的脑保护方法行弓部手术是安全可行的,术后24 h血清NSE>29.65 ng/ml提示神经系统并发症。

Objective This study was to investigate the predictive value of serum neuron-specific enolase(NSE)on neurolog ical complications after aortic arch surgery by using cerebral oxygenation-oriented bilateral antegrade cerebral perfusion.Methods Twenty-five patients(age 49.8±12.0 years;male 20(80%))who underwent aortic arch surgery by using cerebral oxygenation-orien ted bilateral antegrade cerebral perfusion were enrolled in this study from January 2019 to December 2019.According to neurologic out comes(including TND(temporary neurologic dysfunction)and PND(permanent neurologic dysfunction)),patients were divided into two groups.We compared serum NSE levels before and at 0h、6h、24h after operation between the two gruops,and predicted postopera tive neurologic outcomes.Results Neurological complications occurred in 6(24%)patients after surgery(TND=5;PND=1).There was no significant difference between the two groups in basic and intraoperative cerebral oxygenation(P>0.05).Serum NSE levels at 0h,6h,and 24h after the operations in the neurological complications group were higher than those in the non-neurological complica tions group(P<0.05).Receiver-operating characteristic curve analysis showed that the cutoff value of NSE level was 29.65 ng/mL for neurological complications(sensitivity 0.833;specificity 0.789),AUC was 0.851(95%CI 0.693-1.000).Conclusion Cerebral oxy genation-oriented bilateral antegrade cerebral perfusion strategy was safe and feasible for arch surgery.Serum NSE greater than 29.65 ng/mL at 24 hours after the operation indicated adverse neurological complications.