赛培新增产品文献：人NSE，S100B ELISA试剂盒

发布时间：2022-04-08 12:11:45

心脏手术患者术中脑组织氧饱和度和神经损伤 标志物与术后谵妄的关联性研究 

周俊辉， 高 洁， 孟宪慧 基金项目: 河南省重点研发与推广专项( 科技攻关) 项目( 编号: 212102310720) 作者单位: 450008 郑州，河南省胸科医院麻醉科( 周俊辉，孟宪慧) ; 100037 北京，中国医学科学院阜外医院麻醉科( 高 洁) 作者简介: 周俊辉，医学硕士，主治医师，研究方向: 心胸外科手术麻醉与脏器保护。E-mail: zhicungaoyuan1985@ 163． com 通信作者: 孟宪慧，大学本科，医学学士，主任医师，研究方向: 心胸外科手术麻醉与脏器保护。E-mail: 13939029331@ 163． com ［摘要］ 目的 探讨心脏手术患者术中脑组织氧饱和度( rScO2 ) 和神经损伤标志物与术后谵妄( POD) 的关联性。方法 选择 2020 年 1 月至 2021 年 6 月于河南省胸科医院行体外循环( CPB) 下心脏瓣膜置换手 术患者 60 例，剔除 3 例，根据患者术后 3 d 内发生 POD 情况将其分为 POD 组( 15 例) 和非 POD 组( NPOD 组， 42 例) 。术中应用近红外光谱仪连续监测患者 rScO2 和脉搏血氧饱和度( SpO2 ) ，计算动脉-脑组织氧饱和度 差( da-rScO2 ) 。分别于麻醉诱导前 10 min( T0 ) 、麻醉诱导后 10 min( T1 ) 、CPB 开始即刻( T2 ) 、CPB 结束时( T3 ) 、 术毕( T4 ) 、入重症监护室( ICU) 时( T5 ) 、术后 1 d( T6 ) 、术后 2 d( T7 ) 和术后 3 d( T8 ) 抽取患者中心静脉血，用 ELISA 法测定血清中神经损伤标志物 S100β 蛋白和神经元特性烯醇化酶( NSE) 的水平。比较两组以上观测 数据并分析其与 POD 发生的关联性。结果 两组年龄、体重、身高、性别、病因、合并症、吸烟史、饮酒史，以及 基础血氧饱和度、rScO2 基线值等比较差异无统计学意义( P ＞ 0. 05) 。与 NPOD 组比较，POD 组主动脉阻断时 间较长，脑灌注时间、CPB 时间较短，但差异均无统计学意义( P ＞ 0. 05) 。POD 组术中 rScO2 降低的幅度 ＞ 25% 持续时间显著长于 NPOD 组( P ＜ 0. 05) 。在 CPB 过程中，POD 组平均动脉压最小值和 rScO2 最小值小于 NPOD 组，而 da-rScO2 最大值以及 da-rScO2 ＞ 50% 持续时间、da-rScO2 ＞ 40% 持续时间、rScO2 ＜ 50% 持续时间、 rScO2 ＜ 40% 持续时间均显著大于 NPOD 组，差异有统计学意义( P ＜ 0. 05) 。在 T0 ～ T8 时两组血清神经损伤 标志物 S100β 和 NSE 水平均呈上升趋势，且 POD 组上升幅度更大。在 T2 ～ T8 时间点，POD 组的血清 S100β 和 NSE 水平均高于 NPOD 组，差异有统计学意义( P ＜ 0. 05) 。多因素 logistic 回归分析结果显示，在 CPB 过程 中更长的 rScO2 降低幅度 ＞ 25% 持续时间、rScO2 ＜ 40% 持续时间和 da-rScO2 ＞ 50% 持续时间，以及更高水平 的血清 S100β 和 NSE 是促进 POD 发生的危险因素( P ＜ 0. 05) 。结论 CPB 过程中，更长的 rScO2 降低幅度 ＞ 25% 持续时间、rScO2 ＜ 40% 持续时间和 da-rScO2 ＞ 50% 持续时间是 CPB 下心脏手术患者发生 POD 的危险因 素，而神经损伤标志物 S100β 和 NSE 水平的升高也与 POD 发生具有关联。 ［关键词］ 体外循环; 术后谵妄; 脑组织氧饱和度; 心脏手术; 神经损伤标志物 ［中图分类号］ Ｒ 614 ［文献标识码］ A ［文章编号］ 1674 － 3806( 2022) 01 － 0029 － 06 doi: 10． 3969 /j． issn． 1674 － 3806． 2022． 01． 06 A 

study on the correlation of intraoperative regional cerebral oxygen saturation and nerve injury markers with postoperative delirium in patients undergoing heart surgery ZHOU Jun-hui，GAO Jie，MENG Xian-hui． Department of Anesthesiology，Henan Provincial Chest Hospital，Zhengzhou 450008，China ［Abstract］ Objective To explore the correlation of intraoperative regional cerebral oxygen saturation( rScO2 ) and nerve injury markers with postoperative delirium( POD) in patients undergoing heart surgery． Methods Sixty patients undergoing heart valve replacement surgery under cardiopulmonary bypass( CPB) in Henan Provincial Chest Hospital from January 2020 to June 2021 were selected，and 3 of them were excluded． The patients were divided into POD group( 15 cases) and non-POD group( NPOD group，42 cases) according to the occurrence of POD within 3 days after operation． During the operation，a near-infrared spectrometer was used to continuously monitor the patients' rScO2 and pulse · 92 · 中国临床新医学 2022 年 1 月 第 15 卷 第 1 期oximetry( SpO2 ) ． The difference in artery-rScO2 ( da-rScO2 ) was calculated． The patients' central venous blood was drawn to determine the serum levels of nerve injury marker S100β protein and neuron-specific enolase( NSE) 10 minutes( min) before induction of anesthesia( T0 ) ，10 min after induction of anesthesia( T1 ) ，immediately after CPB( T2 ) ，at the end of CPB( T3 ) ，after operation( T4 ) ，when the patients were admitted to the intensive care unit( ICU) ( T5 ) ，and 1 day( T6 ) ， 2 days( T7 ) and 3 days( T8 ) after operation，respectively，using enzyme-linked immunosorbent assay( ELISA) method． The above observation data were compared between the two groups，and the correlation between these observation data and the occurrence of POD was analyzed． Ｒesults There were no significant differences between the two groups in age， weight，height，gender，etiology，comorbidities，history of smoking，history of drinking，as well as basic blood oxygen saturation and baseline value of rScO2 ( P ＞ 0. 05) ． Compared with the NPOD group，the POD group had longer aortic occlusion time，shorter cerebral perfusion time and CPB time，but the differences were not statistically significant( P ＞ 0. 05) ． The duration of intraoperative reduction of rScO2 ＞ 25% in the POD group was significantly longer than that in the NPOD group( P ＜ 0. 05) ． During CPB，the minimum mean arterial pressure and the minimum rScO2 in the POD group were lower than those in the NPOD group，while the maximum da-rScO2 and the duration of da-rScO2 ＞ 50% ， the duration of da-rScO2 ＞ 40% ，the duration of rScO2 ＜ 50% and the duration of rScO2 ＜ 40% in the POD group were significantly greater than those in the NPOD group，and the differences were statistically significant( P ＜ 0. 05) ． From T0 to T8，the levels of serum nerve injury markers S100β and NSE in the two groups showed an upward trend， and the increase in the POD group was greater． From T2 to T8 time points，the levels of serum S100β and NSE in the POD group were higher than those in the NPOD group，and the differences were statistically significant( P ＜ 0. 05) ． The results of multivariate logistic regression analysis showed that the longer duration of rScO2 reduction ＞ 25% ，the duration of rScO2 ＜ 40% and the duration of da-rScO2 ＞ 50% during CPB，and higher levels of serum S100β and NSE were the risk factors promoting the occurrence of POD( P ＜ 0. 05) ． Conclusion During CPB，longer duration of rScO2 reduction ＞ 25% ，duration of rScO2 ＜ 40% ，and duration of da-rScO2 ＞ 50% are risk factors for promoting the occurrence of POD in patients undergoing heart surgery under CPB，and the elevated levels of nerve injury markers S100β and NSE are also associated with the occurrence of POD． ［Key words］ Cardiopulmonary bypass( CPB) ; Postoperative delirium( POD) ; Ｒegional cerebral oxygen saturation( rScO2 ) ; Heart surgery; Nerve injury markers

心脏手术患者术中脑组织氧饱...志物与术后谵妄的关联性研究_周俊辉.pdf