Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients,...Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients, 20 with congenital heart disease (CHD) and 20 of rheumatic heart disease (RHD) , were divided into 2 groups: Control group (group A, n =20) including 10 patients suffering from CHD as group Al and the left 10 from RHD as group A2; and experiment group (group B, n =20) which consisting of group B1 (10 with CHD) and group B2 (10 of RHD). The patients in group A underwent traditional arrested-heart procedures, and those in group B were operated on with beating-heart procedures. Arterial blood samples were collected at preoperation (time A) , 20 min after cardiopul-monary bypass (CPB) starting (time B) , 1 h after CPB (time C) and 24 h postoperation (time D) respectively. Plasma contents of neuron-specific enolase (NSE) and protein S-100b were measured with sensitive ELISA. All the patients received echoencephalography (EEG) before and 1 week after operation. Results: The plasma contents of protein S-lOOb were increased very significantly at time B, C and D in comparison with those at time A (P<0.01) , and that of patients in group Al was significantly higher than that in group B at time B (P < 0. 05 ). There was no significant difference at other time points. At time B, the plasma contents of NSE were significantly higher in group A than in group B, and in group Al and Bl than in group A2 and B2. What's more, at time B, the former fell back to their pre-operative levels, but the latter remained still higher levels than the preoperative ones ( P < 0.01). No significant difference was found in the abnormality rates of postoperative EEG between 2 groups. Conclusion: The perioperative plasma contents of NSE and protein S-100b are not significantly higher in group B than in group A. On-pump beating-heart procedures do not make more serious cerebral dysfunction than the traditional arrested-heart procedures.展开更多
Objective: To investigate the effects of Propofol combined with remifentanil on serum levels of MBP, NSE and S100B protein, D-D and inflammatory factors in patients with acute craniocerebral trauma. Methods: A total o...Objective: To investigate the effects of Propofol combined with remifentanil on serum levels of MBP, NSE and S100B protein, D-D and inflammatory factors in patients with acute craniocerebral trauma. Methods: A total of 100 patients were selected with traumatic brain injury who underwent emergency surgery from August 2014 to May 2017 in our hospital, then randomly divided them into the control group and the experimental group, 50 cases each. The control group received isoflurane combined with remifentanil to maintain anesthesia, and the experimental group received propofol and remifentanil to maintain anesthesia. The inflammatory factors and the levels of MBP, NSE, S100B and D-D in the two groups before and after anesthesia (T0), 1H (T1) and postoperative 1H (T2) were detected and compared. Results: There was no significant difference between the two groups in the levels of TNF-α. The serum level of hs-CRP in two groups of T1, T2 increased significantly, the difference was statistically significant compared with T0, in the experimental group, serum level of hs-CRP at T1 and T2 was significantly higher than the control group, the difference was statistically significant. Conclusion: Propofol combined with remifentanil anesthesia for acute craniocerebral trauma can maintain the balance of inflammatory cytokine levels during the perioperative period, inhibit the elevation of serum MBP, NSE, S100B protein and D-D levels, reduce brain cell damage. It has a good protective effect on brain cells and is worthy of clinical application.展开更多
文摘Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients, 20 with congenital heart disease (CHD) and 20 of rheumatic heart disease (RHD) , were divided into 2 groups: Control group (group A, n =20) including 10 patients suffering from CHD as group Al and the left 10 from RHD as group A2; and experiment group (group B, n =20) which consisting of group B1 (10 with CHD) and group B2 (10 of RHD). The patients in group A underwent traditional arrested-heart procedures, and those in group B were operated on with beating-heart procedures. Arterial blood samples were collected at preoperation (time A) , 20 min after cardiopul-monary bypass (CPB) starting (time B) , 1 h after CPB (time C) and 24 h postoperation (time D) respectively. Plasma contents of neuron-specific enolase (NSE) and protein S-100b were measured with sensitive ELISA. All the patients received echoencephalography (EEG) before and 1 week after operation. Results: The plasma contents of protein S-lOOb were increased very significantly at time B, C and D in comparison with those at time A (P<0.01) , and that of patients in group Al was significantly higher than that in group B at time B (P < 0. 05 ). There was no significant difference at other time points. At time B, the plasma contents of NSE were significantly higher in group A than in group B, and in group Al and Bl than in group A2 and B2. What's more, at time B, the former fell back to their pre-operative levels, but the latter remained still higher levels than the preoperative ones ( P < 0.01). No significant difference was found in the abnormality rates of postoperative EEG between 2 groups. Conclusion: The perioperative plasma contents of NSE and protein S-100b are not significantly higher in group B than in group A. On-pump beating-heart procedures do not make more serious cerebral dysfunction than the traditional arrested-heart procedures.
基金The Natural Science Foundation of Shaanxi Province(2016JQ2341).
文摘Objective: To investigate the effects of Propofol combined with remifentanil on serum levels of MBP, NSE and S100B protein, D-D and inflammatory factors in patients with acute craniocerebral trauma. Methods: A total of 100 patients were selected with traumatic brain injury who underwent emergency surgery from August 2014 to May 2017 in our hospital, then randomly divided them into the control group and the experimental group, 50 cases each. The control group received isoflurane combined with remifentanil to maintain anesthesia, and the experimental group received propofol and remifentanil to maintain anesthesia. The inflammatory factors and the levels of MBP, NSE, S100B and D-D in the two groups before and after anesthesia (T0), 1H (T1) and postoperative 1H (T2) were detected and compared. Results: There was no significant difference between the two groups in the levels of TNF-α. The serum level of hs-CRP in two groups of T1, T2 increased significantly, the difference was statistically significant compared with T0, in the experimental group, serum level of hs-CRP at T1 and T2 was significantly higher than the control group, the difference was statistically significant. Conclusion: Propofol combined with remifentanil anesthesia for acute craniocerebral trauma can maintain the balance of inflammatory cytokine levels during the perioperative period, inhibit the elevation of serum MBP, NSE, S100B protein and D-D levels, reduce brain cell damage. It has a good protective effect on brain cells and is worthy of clinical application.
