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

尽管体外循环（CPB）技术和手术技术不断进步，但一些接受心脏或胸主动脉手术的患者在术中和围术期明显存在压倒性的神经功能障碍并发症，这一事实仍然存在。为了评价S-100B、SjvO_2或近红外光谱（NIRS）等几种脑监测方法对CPB中脑损伤情况的判断准确性，我们研究了行心脏和/或胸主动脉手术合并CPB的患者。在本研究中，CPB过程中术后神经系统并发症与S 100B水平无相关性。虽然我们的数据表明，神经系统并发症的严重程度可以通过CPB术后12、24和48小时的S-100B晚期释放值来表示，但早期（CPB期间或CPB后不到5小时）的血清S-100B蛋白可能不是术后神经系统预后的良好预测指标。此外，我们的数据揭示了在操作过程中，细胞氧化还原行为的三种变化模式；患者实际表现模式与神经系统预后高度相关（p<0.0001），但NIRS和SjvO2的血红蛋白氧合无显著相关性。在本研究中，cyt.ox.的氧化还原行为。手术期间可能是术后脑预后的一个很好的预测指标，这意味着脑组织氧充分性可以通过近红外测量细胞色素氧化酶来评估。此外，持续监测cyt.ox。作为一种评估介入性脑保护方案的方法显示出巨大的潜力，积极的大脑管理与细胞活性蛋白监测可能改善术后神经预后。

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.