Monitoring of cognitive dysfunction during cardiopulmonary bypass and establishment of ideal cerebral management

尽管在心肺转流（CPB）和手术技术的进步，事实仍然是，一些接受心脏或胸主动脉手术的患者在手术和围手术期遭受明显的压倒性并发症的神经功能障碍。本文以体外循环心脏和/或胸主动脉手术患者为研究对象，评价几种脑监护（S-100 B、SjvO_2和近红外光谱（NIRS））对体外循环中脑损伤时机判断的准确性。在本研究中，术后神经系统并发症与CPB期间的S 100 B水平之间无相关性。尽管我们的数据表明，神经系统并发症的严重程度可以通过体外循环后12、24和48小时晚期释放S-100 B获得的值来指示，但早期阶段（体外循环期间或体外循环后不到5小时）的血清S-100 B蛋白可能不是术后神经系统预后的良好预测因素。此外，我们的数据揭示了手术过程中cyt.ox氧化还原行为的三种变化模式;特定患者表现出的实际模式与神经学预后高度显著相关（p<0.0001），但NIRS和SjvO 2的血红蛋白氧合没有相关性。在这项研究中，cyt. ox的氧化还原行为。在手术中，可能是一个很好的预测术后脑的结果，这意味着脑组织氧充足度可以通过近红外测量细胞色素氧化酶来评估。此外，连续监测cyt. ox。作为评估干预性脑保护方案的一种方法显示出巨大的潜力，并且通过监测cyt.ox进行积极的脑管理可能会改善术后神经预后。

Despite advances in the technology of cardiopulmonary bypass(CPB) and surgery, the fact still remains that some patients undergoing cardiac or thoracic aortic surgery suffer the obvious overwhelming complication of neurological dysfunction in the operative and perioperative periods. In this paper, to evaluate the accuracy of a few brain monitoring (S-100B, SjvO_2 or near-infrared spectroscopy(NIRS)) about detecting the occasion of cerebral injury during CPB, we studied patients who had undergone cardiac and/or thoracic aortic surgery with CPB. In the current study, there was no correlation between postoperative neurological complications and S 100B levels during CPB. Although our data indicate that the severity of neurological complication was indicated by the values obtained for late release S 100B at 12,24,and 48 h after CPB, the serum S-100B protein in the early phase(during CPB or less than 5 h after CPB) may be not a good predictor of the postoperative neurological prognosis. Furthermore, our data revealed three patterns of change in the redox behavior of cyt.ox.during the operation ; the actual pattern exhibited by a given patient showed a highly significant correlation with the neurological prognosis (p<0.0001), but hemoglobin oxygenation by NIRS and SjvO2 did not. In this study, the redox behavior of cyt.ox. during an operation is likely to be a good predictor of postoperative cerebral outcome, which implies that brain tissue oxygen sufficiency can be evaluated by near-infrared measurement of cytochrome oxidase. Furthermore, continuous monitoring of cyt.ox. shows great potential as a way of assessing interventive cerebroprotective regimens, and aggressive cerebral management with cyt.ox.monitoring may improve the postoperative neurological prognosis.