Wang Yong, Xiao Ying-Bin, Chen Lin, Zhong Qian-Jin, Wang Xue-Feng
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Chin J Traumatol. 2005 Aug;8(4):249-52.
To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease.
Forty patients with congenital heart disease (CHD, CHD group, n = 20) or rheumatic heart disease (RHD, RHD group, n = 20) underwent on-pump (cardiopulmonary bypass, CPB) heart-beating open heart surgery. Blood samples before CPB, and 20 minutes, 1 hour, 24 hours and 7 days after CPB were collected, and the levels of neuron-specific enolase (NSE) and protein S-100b in the plasma were determined with enzyme-linked immunoadsorbent assay (ELISA), respectively. All the patients were examined with electroencephalogram (EEG) before and 1 week after operation. The changes of NSE, S-100b and EEG compared to verify the difference of postoperative cerebral injury between CHD cases and RHD cases.
The plasma level of S-100b increased significantly 20 minutes after CPB and was still higher than the preoperative level at 24 hours after operation in both groups (P < 0.01). The plasma level of NSE increased more significantly in the CHD group than in the RHD group 20 minutes after CPB and it returned to the normal level 24 hours after CPB in the CHD group but remained at a high level in the RHD group (P < 0.01). The levels of NSE and S-100b returned to the normal levels on the 7th day after CPB. Abnormal EEG was found in 75% of the patients in the CHD group and 60% in the RHD group.
On-pump heart-beating open heart surgery can cause certain cerebral injury in the patients with CHD or RHD. The injury was more severe and recovered more quickly in the CHD group than in the RHD group.
比较心脏直视手术对先天性和风湿性心脏病患者脑组织的不同影响。
40例先天性心脏病（CHD，CHD组，n = 20）或风湿性心脏病（RHD，RHD组，n = 20）患者接受体外循环（心肺转流，CPB）下心脏跳动心脏直视手术。采集CPB前、CPB后20分钟、1小时、24小时和7天的血样，分别采用酶联免疫吸附测定法（ELISA）测定血浆中神经元特异性烯醇化酶（NSE）和蛋白S - 100b的水平。所有患者在术前和术后1周进行脑电图（EEG）检查。比较NSE、S - 100b和EEG的变化，以验证CHD病例和RHD病例术后脑损伤的差异。
两组患者CPB后20分钟血浆S - 100b水平均显著升高，术后24小时仍高于术前水平（P < 0.01）。CPB后20分钟，CHD组血浆NSE水平升高比RHD组更显著，CHD组CPB后24小时恢复至正常水平，而RHD组仍维持在高水平（P < 0.01）。CPB后第7天，NSE和S - 100b水平恢复至正常水平。CHD组75%的患者和RHD组60%的患者出现脑电图异常。
体外循环下心脏跳动心脏直视手术可导致CHD或RHD患者发生一定程度的脑损伤。CHD组的损伤比RHD组更严重，但恢复更快。
