S100蛋白在体外循环术后认知功能障碍评价中意义.docVIP

S100蛋白在体外循环术后认知功能障碍评价中意义 　作者：陈斌，李云涛，左友波，吴爽 【摘要】 目的 探讨血浆S100蛋白水平在体外循环（cardiopulmonary bypass,CPB）术后认知功能障碍评价的临床意义。方法 选择拟行人工心脏瓣膜置换术患者64例，分别于CPB前5 min(T1)、CPB后30 min(T2)、CPB结束时(T3)、术后6 h(T4)、24 h(T5)和48 h(T6)6个时点采血测定S100蛋白浓度。在术前1天和术后第9天对患者进行神经精神功能9项测验，使用Newman评定标准判断患者是否发生了术后认知功能障碍，并将患者分为正常组（A组）和认知功能障碍组（B组）进行对照研究。 结果 62例患者完成了术后测验，术后认知功能障碍发生率48.4%（30/62例）。CPB期间，两组S100蛋白浓度较CPB前明显升高（Plt;0.01）。A组和B组比较，T1时点两组S100蛋白无统计学差异（Pgt;0.05），其它各时点两组S100蛋白均有统计学差异（Plt;0.01）。结论 血浆S100蛋白水平在CPB术后认知功能障碍的评价中具有良好的监测意义。 【关键词】 S100蛋白； 体外循环； 认知功能障碍 Abstract: OBJECTIVE To research the significance of S100 protein in the evaluation of postoperative cognitive dysfunction after cardiopulmonary bypass(CPB). METHODS Sixty-four patients who had been scheduled to receive cardiac valve replacement were selected. The level of serum S100 protein was measured 5 min before CPB(T1), 30 min after CPB(T2), at the end of CPB(T3), 6 h(T4), 24 h(T5) and 48 h(T6) after surgery. A battery of 9 neuropsychological tests was performed and scored preoperatively and 9 days after surgery. Newman’s criterion was used to decide whether patients had happened postoperative cognitive dysfunction, and then divided patients into normal group (group A) and cognitive dysfunction group (group B) for control study. RESULTS Both preoperative and postoperative neuropsychological tests were completely performed for sixty-tow patients. The incidence rate of postoperative cognitive dysfunction was 48.4%(30/62 cases). During CPB, the level of serum S100 protein of two groups was higher than that before CPB（Plt;0.01）. Compared with group A, the level of group B’s serum S100 protein was significant higher at all times（Plt;0.01）exclude T1.CONCLUSION The level of serum S100 protein is very valuable for monitoring postoperative cognitive dysfunction after CPB. Key words： S100 protein; Cardiopulmonary bypass; Cognitive dysfunction 随着麻醉、手术和体外循环（cardiopulmonary bypass,CPB）技术的进步，心脏手术患者的死亡率和术后严重神经系统并发症的发生率已明显降低，但术后患者脑功能障碍的发生率仍然较高［1-2］，是影响心脏外科手术预后