Dragas Marko, Koncar Igor, Opacic Dragan, Ilic Nikola, Maksimovic Zivan, Markovic Miroslav, Ercegovac Marko, Simic Tatjana, Pljesa-Ercegovac Marija, Davidovic Lazar
Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Faculty of Health, Medicine and Life Sciences, Department of Physiology, Maastricht University, Maastricht, The Netherlands.
PLoS One. 2015 Apr 10;10(4):e0124067. doi: 10.1371/journal.pone.0124067. eCollection 2015.
To evaluate the changes in serum neuron specific enolase and protein S-100B, after carotid endarterectomy performed using the conventional technique with routine shunting and patch closure, or eversion technique without the use of shunt.
Prospective non-randomized study included 43 patients with severe (>80%) carotid stenosis undergoing carotid endarterectomy in regional anesthesia. Patients were divided into two groups: conventional endarterectomy with routine use of shunt and Dacron patch (csCEA group) and eversion endarterectomy without the use of shunt (eCEA group). Protein S-100B and NSE concentrations were measured from peripheral blood before carotid clamping, after declamping and 24 hours after surgery.
Neurologic examination and brain CT findings on the first postoperative day did not differ from preoperative controls in any patients. In csCEA group, NSE concentrations decreased after declamping (P<0.01), and 24 hours after surgery (P<0.01), while in the eCEA group NSE values slightly increased (P=ns), accounting for a significant difference between groups on the first postoperative day (P=0.006). In both groups S-100B concentrations significantly increased after declamping (P<0.05), returning to near pre-clamp values 24 hours after surgery (P=ns). Sub-group analysis revealed significant decline of serum NSE concentrations in asymptomatic patients shunted during surgery after declamping (P<0.05) and 24 hours after surgery (P<0.01), while no significant changes were noted in non-shunted patients (P=ns). Decrease of NSE serum levels was also found in symptomatic patients operated with the use of shunt on the first postoperative day (P<0.05). Significant increase in NSE serum levels was recorded in non-shunted symptomatic patients 24 hours after surgery (P<0.05).
Variations of NSE concentrations seemed to be influenced by cerebral perfusion alterations, while protein S-100B values were unaffected by shunting strategy. Routine shunting during surgery for symptomatic carotid stenosis may have the potential to prevent postoperative increase of serum NSE levels, a potential marker of brain injury.
评估采用常规技术并进行常规分流和补片修补的颈动脉内膜切除术，或不使用分流的外翻技术进行颈动脉内膜切除术后，血清神经元特异性烯醇化酶和蛋白S - 100B的变化。
前瞻性非随机研究纳入了43例在区域麻醉下接受颈动脉内膜切除术的重度（>80%）颈动脉狭窄患者。患者分为两组：常规使用分流和涤纶补片的常规内膜切除术（csCEA组）以及不使用分流的外翻内膜切除术（eCEA组）。在颈动脉夹闭前、夹闭后及术后24小时采集外周血，测定蛋白S - 100B和NSE浓度。
术后第一天的神经学检查和脑部CT结果与术前对照相比，所有患者均无差异。在csCEA组中，夹闭后（P<0.01）及术后24小时（P<0.01）NSE浓度降低，而在eCEA组中NSE值略有升高（P=无统计学意义），这导致术后第一天两组之间存在显著差异（P=0.006）。两组中夹闭后S - 100B浓度均显著升高（P<0.05），术后24小时恢复至接近夹闭前的值（P=无统计学意义）。亚组分析显示，手术中分流的无症状患者夹闭后（P<0.05）及术后24小时（P<0.01）血清NSE浓度显著下降，而未分流患者无显著变化（P=无统计学意义）。术后第一天使用分流进行手术的有症状患者也发现NSE血清水平下降（P<0.05）。未分流的有症状患者术后24小时NSE血清水平显著升高（P<0.05）。
NSE浓度的变化似乎受脑灌注改变的影响，而蛋白S - 100B值不受分流策略的影响。有症状颈动脉狭窄手术期间常规分流可能有预防血清NSE水平术后升高的潜力，血清NSE水平是脑损伤的一个潜在标志物。
