Studies On Changes Of S-100B,NSE Protein Level During Operation Of Coronary Artery Bypass Graft With Cardiopulmonary Bypass And Influences Of Cerebral Oxygen Metabolism Through Various Anesthetic Methods

Objective: To observe the changes of S-100B, NSE protein level and their influences to cerebral oxygen metabolism at different phase point of various anesthetic methods cardiopulmonary bypass (CPB) coronary artery bypass graft(CABG) with moderate hypothermia. To evaluate the relationship between S-100B, NSE, indexes of cerebral oxygen metabolism and postoperative cerebral injury, mental function.Methods: 40 cases of 50 years old and above patients for selective CABG under CPB were randomly divided into two groups: propofol group (n=20, group P) and fentanyl group(n=20, group F). Blood samples were taken from right internal jugular vein at different phase points: after anesthetic induction (point a), CPB start (point b), CPB over (point c),4 hours after operation(point d), 24 hours after operation (point e), 48 hours after operation (point f). 72 hours after operation (point g). S-100B, NSE protein contents were measured by ELISA. Blood gas analysis, glucose and lactic acid determination were carried out by taking blood samples from right internal jugular vein bulb and radial artery at different phase points: before anesthesia (T₁). immediately after induction of anesthesia (T₂), sawing the sternum (T₃), hypothermia over (T₄), rewarming over (T₅), at the end of bypass (T₆). Cerebral blood flow/cerebral metabolic rate of O₂ (CBF/CMRO₂), cerebral metabolic rate of O₂/ cerebral metabolic rate of glucose (CMRO₂/ CMR_Glu) and advent volume of lactification (ADVL) were also calculated. Patients were divided into groups of postoperative mental disorders (POMD) and non-POMD (NPMD) according to standard neurological function examination and mental measuring scale (MMSE) preoperation, 1st, 3^rd,7^th and 10^th day postoperation each. All the above indexes were analyzed by statistics to investigate the rule of S-100B, NSE and changes of cerebral oxygen metabolic indexes and their relationship with mental and neurological disorders.Result: (1)S-100B: group P and F all began to increase at CPB start point (point b), reached climax at CPB over point (point c), decrease at 4 hours after operation (point d), restore to normal at 48 hours after operation (point f). There were significant differences between two groups at point c, d, e compared with point a (P<0.001); (2) NSE: group P and F all began to...