异氟烷预处理对婴幼儿体外循环心脏直视手术中S100β蛋白和NSE浓度的影响  

Effect of isoflurane pretreatment on serum S100β and NSE in infants during open-heart surgery under cardiopulmonary bypass

作　　者：彭明清[1] 李远[2] 龚放[1] 吴春[3] 杨杰先[3] 

机构地区：[1]重庆医科大学附属永川医院麻醉科,重庆402160 [2]重庆医科大学附属永川医院中心实验室,重庆402160 [3]重庆医科大学附属儿童医院心胸外科,重庆400014

出　　处：《第三军医大学学报》2012年第5期445-447,共3页Journal of Third Military Medical University

摘　　要：目的观察婴幼儿体外循环(cardiopulmonary bypass,CPB)心脏直视手术中异氟烷预处理对脑的保护作用。方法 42例年龄≤3岁的先天性心脏病患儿分为异氟烷预处理组和对照组两组(n=21),行快速麻醉诱导插管后,异氟烷预处理组持续吸入1～1.5 MAC异氟烷,对照组不行异氟烷预处理。两组在术前(T1)、CPB开始5 min(T2)、阻断主动脉(T3)、CPB后30 min(T4)、CPB结束时(T5)、CPB结束后6 h(T6)、24 h(T7)分别采取血样,ELISA法检测血清中S100β蛋白和神经特异性烯醇化酶(NSE)表达变化情况。结果两组术前S100β和NSE无统计学差异(P>0.05);异氟烷预处理组S100β蛋白和NSE从CPB开始到结束后24 h内各时间点与术前相比无显著差异(P>0.05);对照组术前S100蛋白及NSE水平与T4、T5及T6时间点相比有明显差异(P<0.05),与T7时间点相比统计学意义不显著(P>0.05)。S100β蛋白在T5时间点达到最大值,NSE在T6时间点达到最大值。对照组在术后T4～T6时间点与异氟烷预处理组相比显著上升(P<0.05)。对照组(r=0.684)和异氟烷预处理组(r=0.648)S100β蛋白和NSE浓度的变化均呈明显的正相关性(P<0.05)。结论异氟烷预处理后能够显著降低婴幼儿CPB心脏直视手术中S100β和NSE的含量。Objective To determine the brain protective effects of isoflurane pretreatment in infants undergoing open-heart operation with cardiopulmonary bypass（CPB）.Methods A total 42 infants（less than 3 years old） with congenital heart diseases who received surgical treatment in Yongchuan Hospital and Children＇s Hospital during December 2008 to December 2010 were prospectively and randomly divided into 2 matched groups,isoflurane pretreatment group（n=21） and control group（n=21）.In isoflurane pretreatment group,all infants had been inhaled 1 to 1.5 MAC isoflurane continually for over 60 min after ventilation followed by conventional anesthesia,while control group received conventional anesthesia without pretreatment.Blood samples were taken before（T1） and in 5 min after CPB（T2）,immediately after aortic crossclamping（T3）,in 30 min after CPB（T4）,end of CPB（T4）,and in 6 and 24 h after the end of CPB（T6 and T7）.Serum levels of S100β protein and neuron-specific enolase（NSE） were measured by ELISA.Results There was no significant difference in the serum levels of S100β protein and NSE between the 2 groups before operation.But,for the pretreatment group,their serum levels rose slowly but with no significant difference among all the time points before and after CPB（P0.05）.In contrast,in the control group,there was significant differences in the serum levels at T3,T4 and T5 compared with at T1（P0.05）,though no difference was found when compared with T7（P0.05）.Their serum levels of S100β protein and NSE reached the peak at T5 and T7.The levels of f S100 and NSE in control group at T4 to T6 were significant higher than those in pretreatment group（P0.05）.The level of S100β was positively correlated with that of NSE in both groups（r=0.684 and 0.648）.Conclusion Isoflurane pretreatment significantly decreases the serum levels of S100β and NSE during open-heart operation in infants with cardiopulmonary bypass.

关 键 词：体外循环 异氟烷 S100 NSE 脑保护 

分 类 号：R726.542[医药卫生—儿科] R971.2[医药卫生—临床医学]