Shaaban-Ali M, Harmer M, Vaughan R S, Dunne J A, Latto I P, Haaverstad R, Kulatilake E N P, Butchart E G
Department of Anesthesia, University of Wales College of Medicine, Cardiff, UK.
Acta Anaesthesiol Scand. 2002 Jan;46(1):10-6.
The effect of cardiopulmonary bypass temperature and blood gas management on the brain is still controversial. This study was designed to compare the changes in S100beta protein concentration and Mini-Mental State Examination in patients undergoing cold (28 degrees C) vs. warm (34 degrees C) cardiopulmonary bypass using different blood gas strategies (alpha-stat and pH-stat).
Sixty patients were randomly allocated to one of four equal groups (cold alpha-stat, cold pH-stat, warm alpha-stat, warm pH-stat). Serum S100beta concentrations were measured before CPB, directly after CPB, at 4.5 h and at 24 h after CPB. Mini-Mental State Examination was performed one day before surgery and on day five after the operation. Antegrade warm blood cardioplegia (37 degrees C) was used in all patients.
There was no significant difference in postoperative S100beta protein levels between the four groups. Also, there was no interaction between bypass temperature and type of blood gas strategy on S100beta levels after bypass (directly after bypass, 4.5 h and 24 h after bypass). Mini-Mental State Examination score was not affected by blood gas strategy but it was significantly lower in patients undergoing cold cardiopulmonary bypass surgery: median (range), 26 (12-29) vs. 27 (23-30) in warm patients, P = 0.014. There was no significant correlation between Mini-Mental State Examination score 5 days after CPB and S100beta levels at any of the studied time-points after CPB.
These results support the use of warm CPB (34 degrees C) in patients undergoing coronary artery bypass surgery regardless of the type of blood gas strategy.
体外循环温度和血气管理对大脑的影响仍存在争议。本研究旨在比较采用不同血气策略（α稳态和pH稳态）进行低温（28℃）与常温（34℃）体外循环的患者中S100β蛋白浓度和简易精神状态检查表的变化。
60例患者被随机分为四个相等的组之一（低温α稳态、低温pH稳态、常温α稳态、常温pH稳态）。在体外循环前、体外循环刚结束后、体外循环后4.5小时和24小时测量血清S100β浓度。在手术前一天和术后第5天进行简易精神状态检查表评估。所有患者均采用顺行温血心脏停搏液（37℃）。
四组患者术后S100β蛋白水平无显著差异。此外，体外循环温度和血气策略类型对体外循环后（体外循环刚结束后、体外循环后4.5小时和24小时）的S100β水平没有交互作用。简易精神状态检查表评分不受血气策略影响，但在接受低温体外循环手术的患者中显著较低：中位数（范围），低温患者为26（12 - 29），常温患者为27（23 - 30），P = 0.014。体外循环后5天的简易精神状态检查表评分与体外循环后任何研究时间点的S100β水平均无显著相关性。
这些结果支持在冠状动脉搭桥手术患者中使用常温体外循环（34℃），无论采用何种血气策略。
