S100蛋白、神经元特异性烯醇化酶对心肺复苏后脑损伤的评估  

Effect of serum protein S-100 and neuron-specific enolase on brain damage at the early stage after cardiopulmonary resuscitation

作　　者：李海玲[1] 缪文丽[1] 林慧艳[1] 任红贤[1] 刘宏[1] 梁冰[2] 

机构地区：[1]解放军第401医院ICU,山东省青岛266071 [2]解放军第401医院检验科,山东省青岛266071

出　　处：《中华急诊医学杂志》2008年第3期294-297,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨心肺复苏（CPR）后早期血清S100蛋白（S100）、神经元特异性烯醇化酶（NsE）水平对脑损伤的评估作用。方法研究对象为2004年8月至2006年12月院外、院内发生CA，经CPR成功恢复自主循环后收入解放军第401医院ICU的患者共36例，其中8例因存活不足24h剔除，剩余28例。以格拉斯哥预后评分（Glasgow outcome scale GOS）将患者分为A组（包括GOS1～2分）19例和B组（包括GOS3—5分）9例。健康对照12例为C组。所有患者均在ROSC后2h、12h、24h、48h、72h分别采取静脉血，用电化学发光免疫法检测S100、NSE。同时收集入ICU后24h内临床资料，计算各时间段和急性生理学与慢性健康状况Ⅱ、Ⅲ评分及存活概率（APACHEⅡ、Ⅲ、PS）。计量资料数据以均数±标准差（X^-±s）表示，所有数据用SPSS11．5统计软件分析。组间比较采用Mann-WhitneyU检验；ROSC时间与各时间点的S100、NSE水平相关性采用双变量相关分析。P〈0．05为差异具有统计学意义。结果A组APACHEⅡ、Ⅲ评分明显高于B组（P≤0．01），A组的PS、GCS评分明显低于B组（P≤0．01），A组的开始通气时间、ROSC时间比B组明显长（P〈0．05）。A组在2h、12h、48h、72h的S100水平明显高于B组（P≤0，01），而12h、24h、48h、72hNSE水平明显高于B组（P〈0．05），B组在48hS100、NSE水平与健康对照组无明显差异（P〉0．05）。2h、12hS100水平与ROSC时间显著相关（P〈0．05）；12h、24h、48hNSE水平与ROSC时间显著相关（P〈0．05）。结论血清S100、NSE均可作为判断CPR后早期缺氧性脑损伤的生化标志物，两者联合动态检测对于估计ROCS时间、判断继发性脑损伤、指导脑复苏具有一定的临床意义。Objective To evaluate the effects of serum protein S-100 （S-100） and neuron-specific enolase （NSE） on brain damage at the early stage after cardiopulmonary resuscitation （CPR）. Method Totally 36 patients from August 2004 to December 2006 had cardiac arrest in-hospital and out-of-hospital, and successfully restored spontaneous circulation （ROSC） after CPR. After admission to the ICU of the 401th Hospital of PLA, 8 patients were left out of the research list due to their survival time less 24 hours. According to the Glasgow outcome scale （GOS）, all the rest of patient were divided into group A （n= 19, GOS 1, 2） and group B （n=9, GOS 3, 4, 5）. Group C eousisted of 12 healthy vohmteers. The levels of serum S-100 and NSE were detected respectively at 2 h, 12 h, 24 h, 48 h, 72 h after ROSC with lmmtmoluminometrie. At the same time, the clinical data of chronic health evaluation （APACHE） Ⅱ,Ⅲ and probability of survival （PS） during the first 24 hours were collected. The statistical analysis were computed with the Mann-whitney Utest. Spear-man rank correlation coefficieents were calc^ated for the ROSC time, and serum S-100 and NSE levels at each interval. Results APACHE Ⅱ and Ⅲ scores of group A were significantly higher than those of group B （ P 〈 0.01 ）. The PS and GCS scores of group A were significantly lower than those of group B （ P 〈 0.01 ）. In general, the mechanical ventilation was delayed to start after cardiac arrest in patients of group A, therefore, the time elapsed prior to initiating mechanical ventilation and time required for ROSC were obviously longer than those in group B （ P 〈 0.05）. The serum S-100 levels of group A at 2 h, 12 h, 48 h and 72 h after ROSC were significantly higher than those of group B （ P 〈 0.01 ）. The serum NSE levels of group A at 12 h, 24 h, 48 h and 72 h after ROSC were higher than those group B （ P 〈0.05-0.000）. The serum S-100 and NSE levels of group B at 48 h after ROSC were not significantly different fr

关 键 词：心肺复苏 S100蛋白 神经元特异性烯醇化酶 脑损伤 

分 类 号：R459.7[医药卫生—急诊医学]