体外循环对血浆S100β蛋白及神经认知功能影响.doc

体外循环对血浆S100β蛋白及神经认知功能影响 　 作者：刘晓明,龚庆成,王建刚,刘锋,李蔚然,缪娜,刘晓军 【摘要】 目的 研究体外循环（extracorporeal circulation，ECC）心脏术后血浆S100β蛋白的水平与神经认知功能变化的关系，以及影响两者的可能因素。方法 63例ECC下行心脏手术的成年患者，在术前和术后不同时间点采血测定血浆S100β蛋白浓度，并在术前和术后进行认知功能评分，观察术后神经精神并发症。结果 术后1天、2天、7天用标准化神经系统检查均无明显阳性体征。年龄大、ECC时间和阻断时间长、术后有神经精神症状的患者，ECC后1 h血浆S100β蛋白水平显著升高和神经认知功能评分显著降低。结论 血浆S100β蛋白水平变化对早期发现亚临床脑损伤具有重要意义。 【关键词】 体外循环；血浆S100β蛋白；神经认知功能 　　Abstract: OBJECTIVE To research the relationship between the post operative levels of serum S100β protein and the changes of the neurocognitive function,and their relative influencing factors in cardiac surgery with extracorporeal circulation (ECC). METHODS 63 adult patients underwent cardiac operation were studied. Patients’ serum S100β protein levels were measured at different time, neurocognitive functions before and after operation were scored and neuropsychological complications were recorded. RESULTS ECC led to obvious elevating of the levels of serum S100β protein and obvious depression of the neurocognitive functions. The levels of serum S100β protein increased significantly one hour after operation in the patients with eld, long ECC time, long cross-clamp time and postoperative neuropsychological symptoms.The scores of the neurocognitive functions after operation significantly decreased in the patients with postoperative high level of serum S100β protein, long ECC time and long cross-clamp time. CONCLUSION Observing the changes of the levels of serum S100β protein is significant for detecting the sub-clinical cerebral injuries earlier. 　　Key words： Extracoporeal circulation;Serum S100β protein;Neurocognitive function 　　虽然心外科、体外循环（extracorporeal circulation，ECC）、手术技术及设备不断发展，ECC术后早期神经性及精神性损伤的发生率仍较高，尤其以认知功能减退更为常见［1-3］，在术后一周认知功能减退发生率可以达到60%，1/3的患者可以持续到6个月后［4-6］，导致患者住院时间延长，医疗费用增加，生活质量受到影响。降低ECC术后脑神经精神系统并发症，越来越受到重视。寻找一个敏感和高效的方法是研究这个问题的主要困难，神经损害的早期标记物可以对脑损伤的诊断和损害程度提供有价值的帮助。 　　本项目为前瞻性研究，以北京安贞医院心脏外科心脏瓣膜置换术（VR）、冠状动脉旁路移植术（CABG）及先天性心脏病（CHD）手术成人患者为基本单位，随机选取符合条件的自愿者为研究对象。观察心脏手术后血浆S100β蛋白的升高与神经认