【摘要】 目的观察心内直视手术过程中,红细胞压积(HCT)、PaO2、PaCO2、体外循环(CPB)时间与血浆神经元烯醇化酶(NSE)、S-100β蛋白含量之间的关系。方法选择2008年1月至4月在武警广东总队医院心胸外科住院的先天性心脏病患儿40例,于CPB前、CPB中、CPB结束时三个时间点分别采取动脉血,行血气分析,测定HCT、PaO2、PaCO2,同时分离出血浆,-70℃冰箱保存,同时选择该院同期门诊健康对照儿童30例,心脏病组和对照组均用酶联免疫吸附法定量测定血浆NSE、S-100β蛋白含量。结果(1)心脏病组在CPB前的血浆NSE、S-100β与对照组比较,差异无统计学意义(P>0.05);(2)心脏病组中<7岁组与≥7岁组在CPB前、中、结束时的血浆NSE、S-100β比较,差异均无统计学意义(P>0.05),右向左分流组与左向右分流组的患儿在CPB中、CPB结束时的血浆NSE、S-100β蛋白水平比较,差异无统计学意义(P>0.05);(3)CPB开始后,心脏病组血浆NSE水平随时间而逐渐升高,从(8.28±17.01)μg/L升至(38.84±23.80)μg/L,血浆S-100β从(3.11±2.74)μg/L升至(9.37±6.24)μg/L,均具有统计学意义(P<0.05);(4)CPB时间、HCT及PaCO2三个研究因素与血浆NSE、S-100β水平关系密切(P<0.10)。结论围体外循环期间,缩短CPB时间,根据血气分析结果,调节HCT及PaCO2至正常范围,可减少CPB术后中枢神经系统损伤并发症的发生。更多还原

【Abstract】 Objective To observe the relationship between hematocrit(HCT),arterial oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),CPB time and plasma NSE,S-100β levels in the process of cardiopulmonary bypass(CPB)in open heart surgery.Methods Choose 40 children with congenital heart disease in Cardiac Surgery Department of Wu Jing Zong Dui Hospital of Guangdong Province from January to April 2008,take their blood samples to measure HCT,PaO2 and PaCO2 before,during and after CPB,and simultaneously separate the plasma which should be stored in fridge with a temperature of-70°.At the same time 30 children in the same hospital will be chosen for comparison.ELLSA will be adopted to quantitatively measure the NSE and S-100β levels of both groups.Results(1)The differences of plasma NSE and S-100β of pre-CPB and control groups are not significant(P>0.05);(2)The differences in plasma NSE and S-100β protein during and after CPB of the children in both the right to left and left to right shunt groups are of no significance(P<0.05).(3)When CPB starts,plasma NSE keeps surging as time goes by,from(8.28±17.01)μg/L to(38.84±23.80)μg/L,and S-100β also increases from(3.11±2.74)μg/L to(9.37±6.24)μg/L.The differences are significant(P<0.05);(4)Such three factors as CPB time,HCT and PaCO2 have close relations with plasma NSE and S-100β level(P<0.10).Conclusions According to the blood gas analysis,reduction of CPB time and regulation of HCT and partial pressure of carbon dioxide within a normal scale can reduce central nervous system injury complications.更多还原