【作者】 毕燕琳；

【导师】 王斌；

【作者基本信息】 青岛大学 ， 病原生物学， 2005， 硕士

【摘要】 目的:观察不同麻醉方法下中低温体外循环（CPB）冠状动脉搭桥术（CABG）中各时点颈内静脉血S-100B、NSE蛋白水平表达,以及对脑氧代谢指标的影响,评价S-100B、NSE及脑氧代谢指标与术后脑损伤和精神神经功能改变的相关性。 方法:年龄≥50岁择期CPB下行CABG病人40例,随机均分为两组,丙泊酚组（n=20,P组）、芬太尼组（n=20,F组）。分别于麻醉诱导后（a点）、CPB开始（b点）、CPB结束（c点）、术后4h（d点）、24h（e点）、48h（f点）、72h（g点）采取右颈内静脉血,用ELISA方法检测血浆中的S-100B、NSE蛋白含量;于麻醉前（T₁）、麻醉后（T₂）、锯胸骨（T₃）、降温结束（T₄）、复温结束（T₅）、CPB结束（T₆）采取右颈内静脉球部血和桡动脉血进行血气分析、葡萄糖及乳酸测定,并计算脑血流量/脑氧耗比值（CBF/CMRO₂）、脑氧耗/脑糖耗比值(CMRO₂/CMRG_Glu)及乳酸生成量（ADVL）;术前、术后采用标准神经功能检查和简短精神状态量表（MMSE）检查,将病人分为存在精神神经系统并发症（POMD）和无精神神经系统并发症（NPMD）两组,并分别对以上指标进行统计学处理。 结果:（1）S-100B:P组、F组均在CPB开始（b点）时上升、CPB结束（c点）达到高峰、术后4h（d点）开始下降,术后48h（f点）恢复正常。两组内c、d、e点与a点比较差异显著（P<0.001）;（2）NSE:P组、F组均在CPB开始（b点）时上升、术后4h（d点）达到高峰、术后24h（e点）开始下降,术后72h（g点）恢复正常。两组内b、c、d、e点与a点比较差异显著（P<0.001）;（3）术后有8例病人发生POMD发生率为20%,其中P组有2例、F组有6例;（4）按照麻醉方式分组对不同T点脑氧代谢指标T检验,P组与F组SjO₂仅在T₅点有显著差异（P=0.019<0.05）,P组明显高于F组;（5）根据术后出现POMD有否分为POMD组（n=8）、NPMD组（n=32）,对两组不同T点的脑氧代谢指标进行比较,①SjO₂变化POMD组发生颈内静脉血氧去饱更多还原

【Abstract】 Objective: To observe the changes of S-100B、 NSE protein level and their influences to cerebral oxygen metabolism at different phase point of various anesthetic methods cardiopulmonary bypass （CPB） coronary artery bypass graft（CABG） with moderate hypothermia. To evaluate the relationship between S-100B、 NSE, indexes of cerebral oxygen metabolism and postoperative cerebral injury, mental function.Methods: 40 cases of 50 years old and above patients for selective CABG under CPB were randomly divided into two groups: propofol group （n=20, group P） and fentanyl group（n=20, group F）. Blood samples were taken from right internal jugular vein at different phase points: after anesthetic induction （point a）, CPB start （point b）, CPB over （point c）,4 hours after operation（point d）, 24 hours after operation （point e）, 48 hours after operation （point f）. 72 hours after operation （point g）. S-100B、 NSE protein contents were measured by ELISA. Blood gas analysis, glucose and lactic acid determination were carried out by taking blood samples from right internal jugular vein bulb and radial artery at different phase points: before anesthesia （T₁）. immediately after induction of anesthesia （T₂）, sawing the sternum （T₃）, hypothermia over （T₄）, rewarming over （T₅）, at the end of bypass （T₆）. Cerebral blood flow/cerebral metabolic rate of O₂ （CBF/CMRO₂）, cerebral metabolic rate of O₂/ cerebral metabolic rate of glucose (CMRO₂/ CMR_Glu) and advent volume of lactification （ADVL） were also calculated. Patients were divided into groups of postoperative mental disorders （POMD） and non-POMD （NPMD） according to standard neurological function examination and mental measuring scale （MMSE） preoperation, 1st, 3^rd,7^th and 10^th day postoperation each. All the above indexes were analyzed by statistics to investigate the rule of S-100B, NSE and changes of cerebral oxygen metabolic indexes and their relationship with mental and neurological disorders.Result: （1）S-100B: group P and F all began to increase at CPB start point （point b）, reached climax at CPB over point （point c）, decrease at 4 hours after operation （point d）, restore to normal at 48 hours after operation （point f）. There were significant differences between two groups at point c, d, e compared with point a （P<0.001）; （2） NSE: group P and F all began to更多还原