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

体外循环期间认知功能障碍的监测和理想脑管理的建立

• 批准号: 14370491
• 负责人: KANMURA Yuichi
• 金额: $ 8.96万
• 依托单位: Kagoshima University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 2002
• 资助国家: 日本
• 起止时间: 2002 至 2004
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14370491/
• 关键词: Near-infrared spectroscopy; S-100β protein; SjvO2; Cardiopulmonary bypass; post-operative brain injury; cytochrome oxidase; モノアミン; 脳高次機能障害; 近赤外線分光法; S-100b蛋白; 内頚静脈血酸素飽和度

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.

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。虽然我们的数据表明，神经系统并发症的严重程度是由获得的值晚释放S-100 B在CPB后12，24，和48小时，血清S-100 B蛋白在早期阶段（CPB期间或CPB后不到5小时）可能不是一个很好的预测术后神经系统预后。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式显示出巨大的潜力，并且通过cyt.ox.监测进行积极的脑部管理可能会改善术后神经预后。

项目成果

The variable effects of dopamine among human isolated arteries commonly used for coronary bypass grafts

多巴胺对常用于冠状动脉搭桥术的人体离体动脉的不同影响

• 发表时间: 2004
• 期刊: Anesthesia & Analgesia 98
• 作者: Katai R;Tsuneyoshi I;Hamasaki J;Onomoto M;Suehiro S;Sakata R;Kanmura Y
• 通讯作者: Kanmura Y

Re-evaluation of the reliability of cytochrome oxidase--signal study of cardiopulmonary bypass

细胞色素氧化酶可靠性的重新评价--体外循环信号研究

• 发表时间: 2003
• 期刊: Adv Exp Med Biol 540
• 作者: Kakihana Y;Kuniyoshi T;Isowaki S;Tobo K;Nagata E;Okayama N;Kitahara K;Moriyama T;Omae T;Kawakami M;Kanmura Y;Tamura M
• 通讯作者: Tamura M

Relationship between redox behavior of brain cytochrome oxidase and neurological prognosis

脑细胞色素氧化酶氧化还原行为与神经预后的关系

• 发表时间: 2003
• 期刊: Adv Exp Med Biol 530
• 作者: Kakihana Y;Kuniyoshi T;Isowaki S;Tobo K;Nagata E;Okayama N;Kitahara K;Moriyama T;Omae T;Kawakami M;Kanmura Y;Tamura M
• 通讯作者: Tamura M