Effects of mild hypothermic CPB for open heart surgery on cerebral venous blood S-100 protein and neuron-specfic enolase (NSE) levels / 中华麻醉学杂志

ABSTRACT

Objective It was estimated that about 70% patients suffered from mild brain function disturbances after cardiac surgery with CPB Methods for early detection of brain injury after CPB in current use like EEG, transcranial Doppler, CT, MRI are expensive and not sensitive It was repored that combined assays of S 100 protein and NSE were conducive to early detection of brain ischemic injury and prediction of the prognosis The purpose of this study was to assess the changes in cerebral blood S 100 protein and NSE levels during and after open heart surgery with mild hypothermic CPB Methods 15 consecutive ASA Ⅱ Ⅲ patients undergoing elective open heart surgery under CPB were studied Aortic cross clamping time was 30 60 min and CPB time was less than 120 min Patients with hypertension and neurologic or endocrine diseases were excluded Anesthesia was induced with midazolam 0 15mg/kg, fentanyl 5?g/kg and vecuronium 0 1mg/kg Fentanyl 30 50 ?g/kg was continuously infused after tracheal intubation and during CPB Vecuronium was given intermittently to maintain muscle relaxation Midazolam was infused at 0 2mg?kg -1 h -1 during CPB Temperature was reduced to 32℃ 35℃ during CPB Aterial blood pH and PCO 2 were maintained within normal range and Hct between 25% 30% during CPB Internal jugular vein was caunulated and the catheter was advanced retrogradely until jugular bulb Jugular venous blood samples were taken for determination of S 100 protein and NSE content before CPB (A),when mild hypothermia (32℃ 35℃ ) was steadily maintained (B), rewarming to 36℃ (C), 30 min (D),4 6h (E) and 24h (F) after termination of CPB Results (1) After institution of CPB, S 100 protein level increased significantly (P