文章摘要
李 芝,王 俊,钟 斌,黄陈军,陈亦江,邵永丰,仲昭澎,秦建伟.术野灌注CO2气体在体外循环心脏直视术中脑保护作用的研究[J].南京医科大学学报,2014,(9):1240~1243
术野灌注CO2气体在体外循环心脏直视术中脑保护作用的研究
The cerebral protection of carbon dioxide field flooding on open heart surgery with extracorporeal circulation
投稿时间:2014-01-02  
DOI:10.7655/NYDXBNS20140918
中文关键词: CO2  脑保护  体外循环  心脏直视术  术后认知功能障碍
英文关键词: carbon dioxide  cerebral protection  extracorporeal circulation  open heart surgery  postoperative cognitive dysfunction
基金项目:江苏高校优势学科建设工程资助项目(JX10231801)
作者单位
李 芝 南京医科大学第一附属医院心胸外科,江苏 南京 210029 
王 俊 南京医科大学第一附属医院心胸外科,江苏 南京 210030 
钟 斌 南京医科大学第一附属医院心胸外科,江苏 南京 210031 
黄陈军 南京医科大学第一附属医院心胸外科,江苏 南京 210032 
陈亦江 南京医科大学第一附属医院心胸外科,江苏 南京 210033 
邵永丰 南京医科大学第一附属医院心胸外科,江苏 南京 210034 
仲昭澎 南京医科大学第一附属医院心胸外科,江苏 南京 210035 
秦建伟 南京医科大学第一附属医院心胸外科,江苏 南京 210036 
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中文摘要:
      目的:探讨术野灌注CO2气体在体外循环心脏直视术患者中的脑保护作用?方法:2012年6月~2013年3月行体外循环心脏直视术患者97例,随机分为CO2灌注组(Ⅰ组,50例)和对照组(Ⅱ组,47例)?分别于麻醉诱导后5 min(T0)以及主动脉开放后5 min(T1)?1 h(T2)?4 h(T3)和24 h(T4)检测血浆S-100β和神经元特异性烯醇化酶(neuron specific enolase,NSE)水平?两组患者均于手术前及术后第7天采用简易智能状态检查量表(mini-mental state examination,MMSE)评估认知功能?术后认知功能障碍(postoperative cognitive dysfunction,POCD)的诊断以术前测试值为对照,等于或超过1个标准差诊断为POCD?结果:Ⅰ组患者T1~T3时间点的S-100β和T1~T4时间点的NSE水平较T0明显升高(P < 0.05);Ⅱ组患者T1~T4时间点S-100β和NSE水平均较T0明显升高(P < 0.05)?与Ⅱ组比较,Ⅰ组S-100β水平在T1~T4时间点显著降低(P < 0.05),NSE水平在T2~T4时间点也明显降低(P < 0.05)?两组患者中各有2例因病情危重术后第7天无法行MMSE检测,其余患者术后MMSE评分均较术前明显降低(P < 0.05),且Ⅱ组的评分较Ⅰ组降低更明显(P < 0.05)?Ⅰ组术后出现POCD 16例,Ⅱ组为25例,差异有统计学意义(P < 0.05)?结论:术野灌注CO2气体可降低心脏直视术患者术后S-100β和NSE升高的水平,并改善术后早期认知功能,具有脑保护作用,有临床推广价值?
英文摘要:
      Objective:To explore the cerebral protection of carbon dioxide (CO2) field flooding on open heart surgery with extracorporeal circulation(ECC). Methods:From Jun 2012 to Mar 2013,97 patients undergoing open heart surgery with ECC were randomly divided into either CO2 insufflation(group Ⅰ,n = 50)or unprotected controls(group Ⅱ,n = 47). Blood samples were collected from the internal jugular vein at 5 min after anesthesia(T0),5 min(T1),1 h(T2),4 h(T3)and 24 h(T4)after release of the aortic cross-clamp,and the plasma concentrations of S-100β and neuronspecific enolase(NSE)were measured. The mini-mental state examination (MMSE)was performed to assess cognitive function before and 7 days after the operation. It was considered to be postoperative cognitive dysfunction (POCD)when the score decreased ≥ 1 standard deviation. Results:The plasma concentrations of S-100β at T1-T3 and NSE at T1-T4 in group I were higher than those at T0(P < 0.05). The plasma concentrations of S-100β and NSE at T1-T4 in group II were higher than those at T0(P < 0.05). Compared with group II,the concentrations of S-100β at T1-T4 and NSE at T2-T4 in Group Ⅰ were significantly decreased(P < 0.05). MMSE after surgery could not be performed in two patients of each group for reduced physical or mental status on the 7th postoperative day,respectively. The postoperative MMSE scores were significantly reduced in both groups compared with preoperative MMSE scores(P < 0.05),and the score in group Ⅱ was lower than that in group I(P < 0.05). Sixteen patients suffered POCD in group Ⅰ,and 25 cases in group Ⅱ,and the differences were significant(P < 0.05). Conclusion:It is very important to apply CO2 field flooding during open heart surgery,which can reduce the increasing extent of plasma S100β and NSE concentrations,and improve early postoperative cognitive function and cerebral protection.
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