摘要
目的探讨全主动脉弓(全弓)置换并支架象鼻术中局部脑氧饱和度(rScO_(2))监测对围手术期神经认知障碍(PND)的预测价值及S100β蛋白和神经元特异性烯醇化酶(NSE)与PND关系。方法记录65例拟行全弓置换并支架象鼻术的Stanford A型主动脉夹层患者诱导后(T_(1))、体外循环(CPB)开始(T_(2))、深低温停循环(T_(3))、复温到36℃(T_(4))、停CPB 1 h(T_(5))、术毕(T_(6))的rScO_(2)值并分析;于诱导后(T_(a))、复温到36℃(T_(b))、停CPB 1 h(T_(c))、6 h(T_(d))、24 h(T_(e)),用ELISA法检测血浆S100β和NSE浓度。术前、拔管当天及术后7 d通过简易精神状态检查(MMSE)量表评估并分组为PND组和非PND组并进行比较。结果PND发生率为44.6%。T_(2)时两组患者rScO_(2)值低于T_(1)(P<0.05);T_(3)、T_(6)时PND组患者的rScO_(2)值低于T_(1)时和非PND组(P<0.05);PND组患者rScO_(2)较基础值下降最大百分比(rScO_(2)%_(max))高于非PND组(P<0.05);rScO_(2)%_(max)的临界值为>9.89%,曲线下面积(AUC)为0.658(95%CI:0.525~0.791),敏感度和特异性分别为48.3%及75.0%。T_(c)、T_(d)时PND组S100β和NSE浓度高于非PND组(P<0.01);PND组患者在T_(c)、T_(d)时S100β浓度较Ta明显升高(P<0.001),在T_(b)~T_(e)时NSE浓度升高(P<0.01)。结论全弓置换并支架象鼻术后PND的发生与rScO_(2)下降及S100β和NSE水平升高有关。术中rScO_(2)%_(max)>9.89%可作为PND发生的预测指标。
Objective To investigate the predictive value of regional cerebral oxygen saturation(rScO_(2))monitoring during total aortic arch replacement and stent trunk surgery for perioperative neurocognitive disorders(PND)and changes in plasma S100βprotein and neuron-specific enolase(NSE)concentrations and their relationship with PND.Methods Sixty-five Stanford type A aortic dissection patients who planned to undergo total aortic arch replacement and trunk stenting were selected.Their rScO_(2)values were monitored throughout the operation and recorded after induction(T_(1)),the beginning of CPB(T_(2)),during deep hypothermic circulatory arrest(T_(3)),rewarming to 36℃(T_(4)),CPB stop for 1 hour(T_(5)),and post-operation(T_(6)).After induction(T_(a)),rewarming to36℃(T_(b)),1 h(T_(c)),6 h(T_(d))and 24 h(T_(e))after cessation of cardiopulmonary bypass,central venous blood was collected from patients,and the concentrations of S100βprotein and NSE in plasma were detected by ELISA.The patients were divided into PND group and non-PND group by the evaluation of MMSE scale at time of before operation,on the day of extubation,and 7 days after operation.Results The incidence of PND was 44.6%.The rScO_(2)value at T_(2)was significantly lower than that at T_(1)(P<0.05).The rScO_(2)value of PND group at T_(3)and T_(6)was significantly lower than that at T_(1)and non-PND group(P<0.05).The mean value of rScO_(2)and the minimum value of rScO_(2)in PND group were significantly lower than those in non-PND group,while rScO_(2)%_(max)in PND group was significantly higher than that in non-PND group(P<0.05).The intraoperative critical value of rScO_(2)%_(max)was>9.89%,the area under curve(AUC)was 0.658(95%CI:0.525-0.791,P<0.05),and sensitivity and specificity were 48.3%and 75.0%,respectively.The concentrations of S100βprotein and NSE protein in PND group were significantly higher than those in non-PND group at T_(c)and T_(d)(P<0.01).Compared with T_(a),the concentration of S100βprotein in PND group was significantly increased at T_(c)and T_(d)(P<0.001),and the concentration of NSE protein was significantly increased at Tb-Te(P<0.01).CPB time was an independent risk factor for PND.Conclusion The occurrence of PND after total arch replacement and stenting may be related to the decrease of rScO_(2)and the increase of S100βprotein and NSE protein.Intraoperative rScO_(2)%_(max)>9.89%can be a potential predictor of PND.
作者
乔丽梅
李亚雄
王小燕
刘源
字云峰
陈铖
QIAO Limei;LI Yaxiong;WANG Xiaoyan;LIU Yuan;ZI Yunfeng;CHEN Cheng(Department of Anesthesiology,The Third Affiliated Hospital of Kunming Medical University,Kunming 650118;Department of Cardiovascular Surgery,Yan’an Hospital Affiliated to Kunming Medical University,Kunming 650051,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2023年第1期107-114,共8页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
昆明市卫生科技人才培养项目暨“十百千”工程(2020-SW(省)-004)。
