Ekroth R, Thompson R J, Lincoln C, Scallan M, Rossi R, Tsang V
Brompton Hospital, London, England.
J Thorac Cardiovasc Surg. 1989 Jan;97(1):30-5.
Serial measurements of a marker of brain ischemia, creatine kinase isoenzyme BB, were performed in arterial and internal jugular venous blood from 20 infants younger than 1 year of age before and during the first 20 hours after deep hypothermic total circulatory arrest procedures. A two-site monoclonal method was used, and the results were analyzed in relation to age, size, type of cardiac lesion, hemoglobin level, blood glucose level, pH, and duration of the total circulatory arrest. The creatine kinase BB concentrations increased after the arrest, more so in venous than in arterial blood, from 3.2 +/- 0.5 ng/ml to 17.5 +/- 4.5 in arterial blood and from 3.5 +/- 0.5 ng/ml to 18.1 +/- 5.8 in venous blood. Arterial-venous concentration differences correlated with venous concentrations (r = 0.92, p less than 0.01). The duration of the arrest correlated with creatine kinase BB concentrations during reperfusion with correlation coefficients between 0.50 to 0.90 depending of what sequence of the 20-hour sampling period was analyzed. The best correlation was obtained during the first 4 hours of reperfusion. Age, size of the child, and preoperative cyanosis correlated with postoperative creatine kinase BB but were less important than the arrest time, blood glucose level (r = 0.62, p less than 0.01), pH (r = -0.78, p less than 0.01), and hemoglobin level (r = 0.76, p less than 0.01) during reperfusion. It is suggested that a different control of blood glucose level and pH during reperfusion may be of importance to reduce biochemical signs of cerebral dysfunction after deep hypothermic total circulatory arrest procedures.
对20名1岁以下婴儿在深度低温下全循环停止手术前及术后最初20小时内，采集动脉血和颈内静脉血，连续测量脑缺血标志物肌酸激酶同工酶BB。采用双位点单克隆法，并根据年龄、体型、心脏病变类型、血红蛋白水平、血糖水平、pH值及全循环停止时间对结果进行分析。全循环停止后肌酸激酶BB浓度升高，静脉血升高幅度大于动脉血，动脉血从3.2±0.5 ng/ml升至17.5±4.5 ng/ml，静脉血从3.5±0.5 ng/ml升至18.1±5.8 ng/ml。动静脉浓度差与静脉浓度相关（r = 0.92，p<0.01）。停止时间与再灌注期间肌酸激酶BB浓度相关，相关系数在0.50至0.90之间，取决于对20小时采样期的分析顺序。再灌注最初4小时内相关性最佳。年龄、患儿体型及术前紫绀与术后肌酸激酶BB相关，但在再灌注期间不如停止时间、血糖水平（r = 0.62，p<0.01）、pH值（r = -0.78，p<0.01）及血红蛋白水平（r = 0.76，p<0.01）重要。提示在再灌注期间对血糖水平和pH值进行不同控制，可能对减少深度低温下全循环停止手术后脑功能障碍的生化指标具有重要意义。
