Ishida Kazuyoshi, Gohara Toru, Kawata Ryuichi, Ohtake Kazunobu, Morimoto Yasuhiro, Sakabe Takefumi
Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
J Cardiothorac Vasc Anesth. 2003 Feb;17(1):4-9. doi: 10.1053/jcan.2003.2.
To examine whether serum concentrations of S100beta protein and neuron-specific enolase (NSE) are predictors of cerebral damage in cardiovascular surgery.
Prospective clinical study.
University hospital.
Eighteen patients with conventional cardiopulmonary bypass (CPB), 7 with selective cerebral perfusion (SCP), and 3 volunteers (blood samples).
None.
S100beta and NSE were measured in the blood obtained at 7 time points during and after operation. The concentrations of these markers in the blood from the surgical field and the cell-saver device, and the influence of graded hemolysis (in vitro) on the concentrations of these proteins were also examined. The mean values of S100beta in the CPB group (2.08 +/- 2.00 ng/mL) and the SCP group (1.46 +/-0.77 ng/mL) were highest after aortic declamping and after termination of SCP, respectively. The mean values of NSE in the CPB group (29.1 +/- 14.0 ng/mL) and the SCP group (31.2 +/- 13.6 ng/mL) were highest after termination of CPB and at the end of the operation, respectively. Three patients suffered from cerebral complications, but the elevation of these markers during operation was indistinguishable from those in the other patients. Peak concentrations of S100beta protein in the CPB group and NSE in the SCP group were correlated with the duration of aortic cross-clamping and CPB, respectively. S100beta protein and NSE concentrations in the blood from the surgical field were significantly larger than those in arterial blood, whereas the concentrations in the blood in the cell-saving device were not elevated. The concentration of S100beta protein was not influenced by the extent of hemolysis, whereas NSE concentration was markedly elevated by hemolysis.
A large part of the increases in S100beta protein and NSE during CPB and SCP is not attributed to neuronal damage, but to contamination with the blood from the surgical field. To determine whether these markers are useful to predict neurologic complications, it will be necessary to exclude contamination from the surgical field as observed in the present study.
探讨血清S100β蛋白和神经元特异性烯醇化酶（NSE）浓度是否可作为心血管手术中脑损伤的预测指标。
前瞻性临床研究。
大学医院。
18例行传统体外循环（CPB）的患者、7例行选择性脑灌注（SCP）的患者和3名志愿者（采集血样）。
无。
在手术期间及术后7个时间点采集血液，检测S100β和NSE。还检测了手术野和血液回收装置血液中这些标志物的浓度，以及分级溶血（体外）对这些蛋白质浓度的影响。CPB组（2.08±2.00 ng/mL）和SCP组（1.46±0.77 ng/mL）的S100β平均值分别在主动脉阻断后和SCP结束后最高。CPB组（29.1±14.0 ng/mL）和SCP组（31.2±13.6 ng/mL）的NSE平均值分别在CPB结束后和手术结束时最高。3例患者出现脑部并发症，但手术期间这些标志物的升高与其他患者并无差异。CPB组的S100β蛋白峰值浓度和SCP组的NSE峰值浓度分别与主动脉阻断时间和CPB持续时间相关。手术野血液中的S100β蛋白和NSE浓度显著高于动脉血，而血液回收装置中的血液浓度未升高。S100β蛋白浓度不受溶血程度影响，而NSE浓度则因溶血而显著升高。
CPB和SCP期间S100β蛋白和NSE升高的很大一部分并非归因于神经元损伤，而是手术野血液污染。要确定这些标志物是否有助于预测神经并发症，有必要如本研究中那样排除手术野的污染。
