Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland,
Clin Interv Aging. 2018 Sep 25;13:1837-1845. doi: 10.2147/CIA.S177356. eCollection 2018.
The risk of air microembolism during cardiopulmonary bypass (CPB) is high and influences the postoperative outcome, especially in elderly patients. The use of carbon dioxide (CO) atmosphere during cardiac surgery may reduce the risk of cerebral air microembolism. The aim of our study was to assess the influence of CO field flooding on microembolism-induced brain damage assessed by the level of S100ß protein, regarded as a marker of brain damage.
A group of 100 patients undergoing planned mitral valve operation through median sternotomy using standard CPB was recruited for the study. Echocardiography was performed prior to and after the CPB. CO insufflation at 6 L/minute was conducted in the study group. Blood samples for S100ß protein analysis were collected after induction of anesthesia, 2 hours after aorta de-clamping, and 24 hours after operation.
The S100ß level in blood plasma did not differ significantly between the study and the control group (0.13±0.08 µg/L, 1.12±0.59 µg/L, and 0.26±0.23 µg/L and 0.18±0.19 µg/L, 1.31±0.62 µg/L, and 0.23±0.12 µg/L, =0.7, 0.14, and 0.78). The mean increase of the S100ß concentration was 13% lower in the group with CO protection than in the control group (0.988 µg/L vs 1.125 µg/L), although statistically insignificant. Tricuspid valve annuloplasties (TVAs) had significant impact on the increase in S100ß concentration in the treatment group after 24 hours (TVA [-] 0.21±0.09 vs TVA [+] 0.42±0.42, =0.05). In patients <60 years, there were significant differences in the S100ß level 2 and 24 hours after the procedure (1.59±0.682 µg/L vs 1.223±0.571 µg/L, =0.048, and 0.363±0.318 µg/L vs 0.229±0.105 µg/L, =0.036) as compared with younger patients.
The increase in S100ß concentration was lower in the group with CO protection than in the control group. Age and an addition of TVA significantly influenced the level of S100ß concentration in the tests performed 2 hours after aortic clamp release.
体外循环（CPB）期间空气微栓塞的风险很高，会影响术后结果，尤其是老年患者。在心脏手术中使用二氧化碳（CO）气氛可能会降低脑空气微栓塞的风险。本研究的目的是评估 CO 场淹没对 S100ß 蛋白水平评估的微栓塞诱导脑损伤的影响，S100ß 蛋白被认为是脑损伤的标志物。
招募了 100 名计划通过正中胸骨切开术进行二尖瓣手术的患者进行研究。在 CPB 前后进行超声心动图检查。在研究组中以 6 L/分钟的速度进行 CO 吹入。在麻醉诱导后、主动脉钳夹释放后 2 小时和手术后 24 小时采集 S100ß 蛋白分析的血样。
研究组和对照组之间血浆 S100ß 水平无显著差异（0.13±0.08 µg/L、1.12±0.59 µg/L 和 0.26±0.23 µg/L 和 0.18±0.19 µg/L、1.31±0.62 µg/L 和 0.23±0.12 µg/L，=0.7、0.14 和 0.78）。与对照组相比，CO 保护组 S100ß 浓度的平均升高幅度低 13%（0.988 µg/L 与 1.125 µg/L），尽管无统计学意义。三尖瓣环成形术（TVA）对治疗组 24 小时后 S100ß 浓度的升高有显著影响（TVA [-] 0.21±0.09 与 TVA [+] 0.42±0.42，=0.05）。<60 岁的患者术后 2 小时和 24 小时的 S100ß 水平有显著差异（1.59±0.682 µg/L 与 1.223±0.571 µg/L，=0.048，和 0.363±0.318 µg/L 与 0.229±0.105 µg/L，=0.036），与年轻患者相比。
与对照组相比，CO 保护组 S100ß 浓度升高幅度较低。年龄和附加 TVA 显著影响主动脉夹释放后 2 小时测试的 S100ß 浓度水平。
