体外循环术者血清S-100B蛋白浓度及认知功能变化的研究  

Study on the change of serum S-100B protein levels and cognitive function after cardiopulmonary bypass

作　　者：钱怡宁 张茁[1] 

机构地区：[1]首都医科大学附属北京安贞医院神经内科,100029

出　　处：《北京医学》2005年第2期81-84,共4页Beijing Medical Journal

摘　　要：目的观察体外循环术者血清S-100B蛋白浓度和认知功能的变化及二者的相关性。方法选择体外循环下心内直视手术患者35例。术野渗血均经体外循环附加的洗血装置处理后回输。在体外循环术中和术后不同时间点采血测定血清S-100B蛋白浓度,并在术前1d、术后14d进行简易智力状态测试(MMSE)及基本认知能力测试。结果体外循环可引起患者血清S-100B蛋白明显升高〔(1.75±0.44)μg/L〕,水平最高的2(2.96μg/L,例250μg/L)术后均出现明显的神经系统并发症。体外循环术后MMSE评分较术前无显著性差异(P>0.05)。术后基本认知功能测试平均总分较术前有极显著性差异(P<0.001),以知觉速度、工作记忆及字词的短时记忆等变化显著(P<0.01)。术后20例患者出现认知功能减退,其术后24h、48h血清S-100B蛋白浓度均值与术后未出现认知功能减退的15例患者的血清S-100B蛋白浓度比较有显著性差异(分别为P<0.01、P<0.05)。体外循环术后24h血清S-100B蛋白浓度与术后认知功能减退存在相关性(r=0.62,P<0.01)。结论在减少非神经源性血清S-100B蛋白的干扰后,体外循环术后24～48h血清S-100B蛋白浓度对脑损伤的评价具有重要意义。术后24h血清S-100B蛋白浓度显著升高可能能预测体外循环术后早期认知功能减退的发生。Objective To investigate the change of serum S-100B, a marker of cerebral injury, and the correlation between elevated levels of S-100B and the neurocognitive outcome after cardiopulmonary bypass (CPB). Methods 35 patients underwent open heart surgery with CPB were studied. Blood from the surgical field was washed by a centrifugal cell-saving device and retransfused to the bypass circulate. Serum S-100B concentrations were serially assessed at different time intervals. On the day before operation and the 14th day after operation, neurocognitive outcome was evaluated by Mini-Mental State Examination (MMSE) and Basic Cognitive Ability Examination battery on computer. Results CPB initiated the release of S-100B protein. Two patients with the highest level suffered cerebral complication postoperatively. On the 14th day after operation, the total score of MMSE was not significantly differente between preoperative and postoperative period. The total score of Basic Cognitive Ability Examination of postoperative days(48.60 ± 13.85) was lower than that of preoperative days (55.20 ± 11.18) (P < 0.001), especially in Digit Discrimination, Digit Working Memory, Dual-Word Recognition (P < 0.01). 20 patients suffered neurocognitive dysfunction postoperatively. Mean S-100B levels on 24h and 48h postoperative were significantly different between the group of cognitive dysfunction and the group of noncognitive dysfunction.(P < 0.01 and P < 0.05,respectively)Elevated S-100B levels on 24h postoperation was found to correlate with the degree of neurocognitive dysfunction at the 14th day postoperation(r = 0.62,P < 0.01). Conclusions By relieving the interference of extracerebral S-100B protein, the levels of serum S-100B in 24 ～ 48h postoperation has very great significance in evaluating cerebral injury. The elevated levels of serum S-100B on 24h postoperation seems to be a useful blood marker for early cognitive dysfunction after cardiac surgery with CPB.

关 键 词：体外循环 血清S-100B蛋白 浓度 认知功能 脑损伤 

分 类 号：R654.1[医药卫生—外科学]