Comparison of plasma NSE, protein S-100b and EEG changes in traditional arrested-heart procedures and on-pump beating-heart procedures

摘要

Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients, 20 with congenital heart disease (CHD) and 20 of rheumatic heart disease (RHD), were divided into 2 groups: Control group (group A, n=20) including 10 patients suffering from CHD as group A1 and the left 10 from RHD as group A2; and experiment group (group B, n=20) which consisting of group B1 (10 with CHD) and group B2 (10 of RHD). The patients in group A underwent traditional arrested-heart procedures, and those in group B were operated on with beating-heart procedures. Arterial blood samples were collected at preoperation (time A), 20 min after cardiopulmonary bypass (CPB) starting (time B), 1 h after CPB (time C) and 24 h postoperation (time D) respectively. Plasma contents of neuron-specific enolase (NSE) and protein S-100b were measured with sensitive ELISA. All the patients received echoencephalography (EEG) before and 1 week after operation. Results: The plasma contents of protein S-100b were increased very significantly at time B, C and D in comparison with those at time A (P<0.01), and that of patients in group A1 was significantly higher than that in group B at time B (P<0.05). There was no significant difference at other time points. At time B, the plasma contents of NSE were significantly higher in group A than in group B, and in group A1 and B1 than in group A2 and B2. What's more, at time B, the former fell back to their preoperative levels, but the latter remained still higher levels than the preoperative ones (P<0.01). No significant difference was found in the abnormality rates of postoperative EEG between 2 groups. Conclusion: The perioperative plasma contents of NSE and protein S-100b are not significantly higher in group B than in group A. On-pump beating-heart procedures do not make more serious cerebral dysfunction than the traditional arrested-heart procedures.