不停跳心内直视手术对患者术后早期认知功能和S100b的影响  

The effect of beating heart intracardiac procedures on postoperative cognitive function and S100b release:analysis of 51 patients

作　　者：张传汉[1] 李显华[1] 陈林[1] 王建伟[1] 魏翔[1] 姚文龙[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉430030

出　　处：《中华医学杂志》2007年第29期2054-2057,共4页National Medical Journal of China

摘　　要：目的比较停跳与不停跳心内直视手术后早期认知功能障碍和血清 S100b 的差别方法心内直视手术的患者60例。分为停跳组和不停跳组,分别接受停跳和不停跳心内直视手术。分别在术前第1天和术后第7天对患者进行神经精神测验。术前及术后24 h 取患者血标本,运用酶联免疫吸附法测定血清 S100b 蛋白。结果停跳组、不停跳组术后认知功能障碍发生率分别为42.9%、34,8%,两组之间差异无统计学意义。停跳组和不停跳组术后24 h 血清中 S100b 的浓度比较差异无统计学意义。结论心脏不停跳心内直视手术不减少患者术后早期认知功能障碍和血清S100b 的释前。Objective To investigate the effect of beating heart intracardiac procedures on postoperative cognitive function and S100b release. Methods Fifty-one patients, aged 15-45, were divided into 2 groups to undergo intracardiac procedures under the conditions of cardiac arrest （ n = 29, including 14 isolated valve replacement patients and 14 interauricular or interventricular septum repair patients ） or beating heart （n = 23, all undergoing interauricular or interventricular septum repair）. Before the operation and 7 days after the operation, a battery of neuropsychological tests, using trail making test, Wechsler memory scale, and Wechsler adult intelligence scale, was conducted. Forty healthy sex and age-matched volunteers underwent the same neuropsychological tests. The cognitive function impairment was evaluated by calculating the modified reliable change indices （MRCI）. Cognitive function impairment in 2 or more items of the tests was defined as postoperative cognitive dysfunction （POCD. Blood samples were collected preoperatively and 24 h after cardiac surgery to measure the serum S100b by ELISA. Results The incidence of POCD in the arrested heart group was 42.9%, not significantly different from that of the beating heart group （34.8%, P〉0. 05）. The concentration of serum S100b 24 hours after cardiac surgery of the beating heart group was 0.37 ± 0. 17 μg/L, not ignorantly different from that of the arrested heart group （0. 35 ± 0.18 μg/L, P 〉 0.05）. Conclusion Beating heart intracardiac procedures does not decrease the incidence of early cognitive dysfunction after cardiac surgery, and does not reduce the release of S100b.

关 键 词：心脏外科手术 心肺转流术 神经组织蛋白质S100 手术后期间 

分 类 号：R654.2[医药卫生—外科学]