体外循环期间脑氧供需平衡管理对心脏瓣膜置换术患者S-100β蛋白、NSE水平及术后认知功能的影响  

Effects of cerebral oxygen supply-demand balance management during cardiopulmonary bypass on S-100β protein and NSElevels and postoperative cognitive function of patients undergoing heart valve replacement surgery

作　　者：黄赛赛[1] 姚菊[1] 唐标[1] 黄新冲[1] HUANG Saisai;YAO Ju;TANG Biao(Department of Anesthesiology,Affiliated Hospital,Nantong University,Nantong 226001,CHINA)

机构地区：[1]南通大学附属医院麻醉科,江苏226001

出　　处：《江苏医药》2023年第7期705-708,共4页Jiangsu Medical Journal

基　　金：南通市科技计划项目(JC12022003)。

摘　　要：目的探讨体外循环期间脑氧供需平衡管理对心脏瓣膜置换术患者S-100β蛋白、神经元特异性烯醇化酶(NSE)水平及术后认知功能的影响。方法56例在体外循环下行心脏瓣膜置换术的患者随机均分为两组。试验组患者术中除常规的生命体征监测外进行脑氧饱和度(SctO_(2))监测,并以此为导向采用脑氧供需平衡管理;对照组患者进行常规的生命体征监测及相关操作,但不进行SctO_(2)监测及相关的脑氧供需平衡管理。观察两组患者术前1d及术后1、3、5、7d外周血S-100β蛋白、NSE水平及简易精神状态检查量表(MMSE)评分,比较两组患者在麻醉诱导前(T0)、鼻咽温降至低温恒定期(T1)、鼻咽温上升至恒定期(T2)、体外循环结束后1h(T3)时脑动-静脉氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))的变化。结果试验组术后3、5d时MMSE评分高于对照组(P<0.05)。试验组患者术后7d内术后认知功能障碍发生率低于对照组(10.7%vs.32.1%)(P<0.05)。试验组术后1、3、5d时外周血S-100β蛋白及NSE水平低于对照组(P<0.05)。T1~T3时试验组Da-jvO_(2)和CERO_(2)低于对照组(P<0.05)。结论体外循环下心脏瓣膜置换术中进行脑氧供需平衡管理措施能够降低患者术后S-100β蛋白和NSE水平,减少脑组织氧耗,从而减少术后认知功能障碍的发生风险。Objective To investigate the effects of cerebral oxygen supply-demand balance management during cardiopulmonary bypass(CPB)on S-100β protein and neuron specific enolase(NSE)levels and postoperative cognitive function in the patients undergoing heart valve replacement surgery.Methods Fifty-six patients undergoing valve replacement under CPB were randomly divided into two groups of A and B.In addition to routine vital sign monitoring,the patients in group A were monitored for cerebral oxygen saturation(SctO_(2))during operation,and the cerebral oxygen supply-demand balance was managed based on this guidance.The patients in group B were monitored for routine vital signs and relevant management without monitoring SctO_(2),and cerebral oxygen supply-demand.The levels of S-100β protein and NSE in peripheral blood and mini-mental state examination(MMSE)scores of two groups were observed 1 day before surgery and 1,3,5,and 7 days after surgery.The changes in cerebral arterial and venous oxygen content(Da-jvO_(2))and cerebral oxygen uptake rate(CERO_(2))were compared between the two groups at TO(before anesthesia induction),T1(nasopharynx temperature decreased to a low temperature constant stage),T2(nasopharynx temperature increased to a constant stage)and T3(1 hour after CPB).Results The MMSE score of group A was higher than that of group B at 3 and 5 days after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)within 7 days after surgery in group A was lower than that in group B(10.7%vs.32.1%)(P<0.05).The levels of S-100βprotein and NSE in group A at 1,3 and 5 days after surgery were lower than those in group B(P<0.05).At T1-T3,the Da-jvO_(2) and CERO_(2) in group A were lower than those in group B(P<0.05).Conclusion SctO_(2)-oriented management of cerebral oxygen supply-demand balance during valve replacement under CPB can reduce the S-10oβprotein and NSE levels and oxygen consumption of brain tissues,ensure adequate oxygen supply of brain tissues,and reduce the risk of POCD.

关 键 词：心脏瓣膜置换术 S-100Β蛋白 神经元特异性烯醇化酶 体外循环 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]