Brain injury after cardiac surgery
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摘要:
目的通过分析心脏术后反应脑功能损害的指标神经特异性烯醇（NSE）与术前、术后各个因素的相关性，探寻导致心脏术后发生脑损伤的危险因素。 方法相关分析采用Spearman相关方法，分析心脏术后反应脑功能损害的指标NSE与术前、术后各个因素的相关性。 结果心脏术后NSE水平与气管插管时间（r=0.366，P=0.001）、术前氧合指数（r=0.921，P=0.011）、术前ALT有相关性（r=0.193，P=0.008）、术后1 h血肌酐水平（r=0.188，P=0.005）、术后第1天血肌酐水平（r=0.407，P=0.001）、术后第2天血肌酐水平（r=0.370，P=0.001）及术后第3天血肌酐水平（r=0.324，P=0.003）呈正相关，与术后12 h氧合指数（r=−0.421，P<0.01）呈负相关关系。 结论术前氧合指数下降、肝功能不全、术后12 h缺氧、术后出现肾功能障碍、年龄、术前心功能不全是心脏术后发生脑损伤的危险因素。 Abstract:ObjectiveTo explore the relevant factors of postoperative brain damage by analyzing the correlation between NSE and preoperative and postoperative factors. MethodsSpearman correlation method was used to analyze the correlation between neuron specific enolase NSE with various preoperative and postoperative factors. ResultThe concentration of NSE was related to intubation time (P=0.001, r=0.366), preoperative and 12 h after operation oxygenation index (P<0.01), preoperative ALT (P=0.008, r=0.193) and postoperative creatinine. ConclusionThe preoperative and 12 h after operation oxygenation index fell, hepatic insufficiency, postoperative renal dysfunction, age and cardiac dysfunction are the risk factors for brain damage after cardiac surgery. The preoperative renal insufficiency, postoperative liver function, CBP and aortic clip time are not risk factors for brain damage after cardiac surgery. -
Key words:
- cardiac surgery /
- extracorporeal circuIation /
- brain injury /
- neurospecific enol
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表 1 患者一般情况及各个因素与NSE水平的相关性
项目 例数（n) 值（Mean±SD） NSE值（Mean±SD） 年龄（岁） 19~44 23 26.73±7.16 45~70 60 35.03±14.10 性别 男 47 31.33±9.87 女 37 34.36±15.89 手术类型[n（%）] CABG 14（15.6） 先心 11（12.2） 瓣膜置换 63（70.0） 主动脉夹层 12（13.3） 粘液瘤清除 4（4.4） ICU住院时间（d） 74 3.79±2.25 术后住院时间（d） 74 13.34±7.12 体表面积（m2） 84 1.63±0.19 BMI（kg/m2） 84 22.26±3.66 EF（%） 84 60.66±9.59 CPB 时间（min） 84 114.14±72.07 阻断时间（min） 84 87.19±44.68 乳酸 84 3.16±1.93 NYHA 分级 84 
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表 2 各个因素与NSE水平的相关性
相关因素 NSE r P ICU 住院时间 0.155 0.271 术后住院时间 0.233 0.062 体表面积 −0.237 0.033 BMI −0.097 0.378 EF −0.390 0.001 CPB 时间 0.063 0.687 阻断时间 0.101 0.361 乳酸 0.144 0.212 NYHA 分级 −0.345 0.001
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表 3 NSE 与氧合指数相关性分析
呼吸相关因素 NSE r P 插管时间 0.366 0.001 术前氧合指数 0.921 0.011 术后1 h氧合指数 −0.152 0.169 术后12 h氧合指数 −0.421 <0.001 术后24 h氧合指数 −0.216 0.051 术后48 h氧合指数 0.008 0.944 NSE：神经特异性烯醇
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表 4 NSE 与肝功能相关性分析
肝功能相关因素 NSE r P ALT术前 0.193 0.008 ALT术后 0.041 0.712 ALT术后第1天 0.127 0.393 ALT术后第2天 0.125 −0.257 ALT术后第3天 0.193 0.264 AST术前 0.277 0.011 AST术后 0.270 0.014 AST术后第1天 0.270 0.014 AST术后第2天 0.241 0.030 AST术后第3天 0.198 0.075 NSE：神经特异性烯醇；ALT：谷丙转氨酶；AST：谷草转氨酶
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表 5 NSE 与肾功能相关性分析
相关因素--血肌酐水平 NSE r P 术前 0.188 0.089 术后1 h 0.304 0.005 术后第1天 0.407 0.001 术后第2天 0.370 −0.001 术后第3天 0.324 −0.003 NSE：神经特异性烯醇
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