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

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（加温组：使用蠕动装置将身体加温至37.5℃，亚低温组：使用冷却毯将身体冷却至35 ~ 36℃）。采用Sangtec Medical AB，Bromma，Sweden公司生产的免疫放射分析试剂盒，在CPB前、CPB结束时（0 ...更多信息 h）、体外循环结束后5 h、24 h、48 h。体温与羽化时间呈显著负相关（p = 0.0068）。虽然早期血清S-100 B蛋白（CPB期间或CPB后5 h内）可能不是术后神经系统预后的良好预测因子，但通过CPB后12、24和48 h的晚期释放S-100 B获得的值来指示神经系统并发症的严重程度。体温与S100 B延迟释放呈显著正相关。体温与白细胞介素6之间有良好的相关性。因此，我们的数据表明，虽然在ICU中的治疗性亚低温似乎与延迟麻醉后恢复有关，但它可能是通过调节全身炎症反应综合征的干预性脑保护方案的巨大潜力。总之，在重症监护室进行积极的脑管理和治疗性亚低温可以改善术后神经预后。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