Neuroprotective effects of therapeutic mild hypothermia on postoperative brain injury after cardiopulmonary bypass in intensive care units

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。本研究的目的是评估治疗性亚低温对重症监护病房（ICU） CPB术后脑损伤的神经保护作用。胸主动脉手术患者入ICU后分为两组，分别为温热组，使用虫温装置将患者体温加热至37.5℃；亚低温组，使用降温毯将患者体温冷却至35 ~ 36℃。采用市售免疫放射测定试剂盒（Sangtec Medical AB, Bromma, Sweden）在CPB前、CPB结束时（0…More h）、CPB结束后5小时、24小时和48小时测量S-100B蛋白，评估治疗性亚低温对术后脑损伤的神经保护作用。体温与羽化时间呈显著负相关（p = 0.0068）。虽然早期（CPB期间或CPB后不到5小时）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，但CPB后12、24和48小时晚释放S-100B的值表明神经系统并发症的严重程度。体温与晚释S 100B呈显著正相关。体温与白细胞介素6有良好的相关性。因此，我们的数据显示，尽管在ICU中治疗性亚低温似乎与麻醉后恢复延迟有关，但它可能是一种通过调节全身炎症反应综合征作为介入性脑保护方案的巨大潜力。综上所述，在重症监护室进行积极的脑管理和治疗性亚低温可改善术后神经系统预后。少

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. The purpose of this study is to evaluate the neuroprotective effects of therapeutic mild hypothermia on postoperative brain injury after CPB in the intensive care units (ICU). Patients undergoing thoracic aortic surgery were divided into two groups (warming groups; warm their body until 37.5℃ using worming device, and mild hypothermia groups; cool their body at 35〜36℃ using cooling blanket) after admission to the ICU. The neuroprotective effects of therapeutic mild hypothermia on postoperative brain injury was evaluated by S-100B protein, which was measured using a commercially available immunoradiometric assay kit (Sangtec Medical AB, Bromma, Sweden) at five time-points : before CPB, at the end of CPB (0 … More h), and at 5 h, 24 h, and 48 h after the end of CPB. The relationship between the body temperature and the emergence time showed the significant negative correlation (p = 0.0068). Although 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, 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 relationship between the body temperature and the late release S 100B showed the significant positive correlation. There was a good correlation between body temperature and interleukin 6. Therefore, our data shows that although a therapeutic mild hypothermia in ICU seemed to be associated with delayed post-anaesthetic recovery, it may be a great potential as an interventive cerebroprotective regimens by regulating of systemic inflammatory response syndrome. In conclusion, an aggressive cerebral management with a therapeutic mild hypothermia in ICU may improve the postoperative neurological prognosis. Less