Dissertation > Medicine, health > Surgery > Of surgery > Cardiovascular and lymphatic system surgery > Cardiopulmonary bypass and resuscitation

Significance of Serum S100 Protein in the Evaluation of Cerebral Injury after Cardiopulmonary Bypass

Author HeGengXu
Tutor LiBoJun
School PLA Postgraduate Medical School
Course Cardiovascular Surgery
Keywords Cardiopulmonary bypass S100 protein Brain damage Plasma Systemic inflammatory response Neuropsychiatric Neurological examination The end of the loop Protein levels Auxiliary examination
CLC R654.1
Type Master's thesis
Year 2002
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Introduction: Despite advance in anaesthesia , cardiopulmonary bypass ( CPB ) and surgical techniques , cerebral injury remains a major source of morbidity after cardiac surgery. According to the clinical investigation, subtle cerebral injury can be detected by neuropsychometric testing in 60-70 % of patients within a week, and persist in one third of patients 6 months later. A reported incidence of stroke after CABG is 0.9-5.9%. Thoracic aortic surgery utilizing profound hypothermic circulatory arrest has an incidence of permanent neurological deficit of 7-15% and a 19-25% incidence of transient neurological injury. Currently, documentation of neurological deficit relied on crude physical examination, but the battery of neuropsychological and neurophysiological tests for cognitive dysfunction require a specified personnel to perform them, are prolonged and tedious, and are not appropriate for infants and children. Continuous electroencephalograph, transcranial Doppler, computed tomography, and magnetic resonance imaging are methods that have been used to detect cerebral injury, but this methods are expensive and time consuming, and these method are always not suitable for use immediately after cardiac surgery when patients may be unconscious, sedated and artificially ventilated, or haemodynamically unstable, and thus unable to cooperate. A specific biochemical marker for early detection of cerebral injury would be of great value. NSE has been proved to be a useful marker in evaluating the cerebraldamage, but there also exist a high concentration in the red blood cell and platelet, subtle haemolysis will greatly increase its level in serum, thus reduce its specificity in the evaluation of cerebal damage after cardiac surgery. CK-BB also exist in myocardium, the damage of myocardium during CPB and reperfusion injury will also influence its level. SI00 protein is calcium protein present in astroglial and microglial cells and is highly specific for the brain. Some studies on abroad have proven it will increase after CPB and is helpful in cerebral injury detection, especially for ’subclinical’ problem such as cognitive dysfunction. Our this study is to investigate its changing pattern and the value in evaluating in neuropsychological deficit.Material and method: From March to May in 2002, 23 valve replacement, 2 valve replacement combined with CABG and 15 simple congenital heart disease were enrolled in this study. Premedication comprised morphine ,scopolamine. Anaesthesia was induced with fentanyl (3Qug/kg), muscle relaxation was achieved with pancuronium (0.1-0.2mg/kg intravenously). Mechanical ventilation was initiated (tidal volume, 10-15ml/kg; rate, 12-15 breaths per minute) and anaesthesia was supported by inhalation 1% isoflurane. Operative monitoring was identical in all patients. Cardiopulmonary bypass was instituted using a nonpulsatile roller pump, membrane oxygenator, and a -stat acid-base protocol. Mean Pa02 was controlled under 250mmHg. All operations were performed with pump flow 2.4L / m"2/ min"1, moderate hypothermia (28-32癈), and perfusion pressure was maintained pharmacologically between 50-80 mmHg. Blood sample were taken on induction of anaesthesia, 20 minutes after initiating CPB, at the end of CPB, 2 ,4 ,8, 24, 48 hours after the termination CPB. Allsample were centrifuged for 10 minutes at 3000 rpm. The resultant serum was frozen at -20 and saved for batch analysis. Neurophysiological e xamination was taken at the first and seventh day postoperation. Serum S100 protein levels was measured using ELISA; TNF, IL-6, IL-8, ET-1 levels was measured using RIA method.Results: There were neurological events in three patients, two of them were psychological symptoms, the third patient occurred fatally cerebral infarction. The concentrations of SI00 were in normal levels in all patients. After initiating CPB, its level increased significantly, and reached peak level at the end of CPB, then gradually decreased to normal levels at 24-48hours after the CPB in the patients without c

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