设为首页 电子邮箱 联系我们

本刊最新招聘信息请见“通知公告”!  本刊投稿系统试运行中,欢迎投稿!如投稿有问题,可直接将稿件发送至zgyy8888@163.com

 
网站首页杂志简介编委会成员本刊稿约编辑部照片过刊目录广告合作读者论坛联系我们
位置:首页 >> 电子期刊 >> 正文
脑脊液生化指标持续监测对胸腹部主动脉瘤手术脊髓缺血损伤判断的临床意义
作者:李旭  陈龙  涂远荣  
单位:福建医科大学附属第一医院胸外科  南京军区福州总医院胸心外科 
关键词:胸腹部主动脉瘤  脊髓缺血损害  胶质纤维酸蛋白  神经丝蛋白亚单位  S100B蛋白 
分类号:
出版年,卷(期):页码:2007,2(12):705-707
摘要:

目的探讨脑脊液生化指标监测对胸腹部及胸降部主动脉瘤手术中脊髓缺血损害判断的临床意义。方法对43例胸腹部及胸降部人工血管置换手术患者常规使用序贯阻断、左心房股动脉离心泵转流、远端主动脉灌注等脊髓保护措施,同时在蛛网膜下腔置管监测脑脊液压力。术中、术后分10个时点对脑脊液取样,对胶质纤维酸蛋白(GFAP)、神经丝蛋白亚单位(NFL)以及S100B蛋白等3个生化指标进行测定。根据术后是否发生脊髓损害并发症将研究对象分成损伤组和无损伤组,比较分析上述3个生化指标在2组之间的变化。结果损伤组术中各项检测指标无明显升高,但术后3~8 h以后开始升高,最高平均峰值与无症状组平均峰值相比GFAP上升了139倍、NFL上升了4.5倍、S100B上升了7.7倍,其中GFAP测定数值在术后3 h以后2组之间数值无重叠。4例中有2例生化指标异常出现时间分别早于脊髓损害出现时间6 h与19 h,采取积极治疗后,下肢肌力有明显改善。结论脑脊液生化指标持续监测可以预判迟发性脊髓损害,为积极治疗争取时间,其中胶质纤维酸蛋白测定是脊髓缺血损害预判的最具潜力指标。

Objective To investigate the relation between biochemical markers in cerebrospinal fluid (CSF)and spinal cord ischemia during thoracoabdominal aortic or descending thoracic aortic aneurysm(TAAA/ DTAA)repair operation and its postoperative period.Methods From Jan 2005 to Sep 2006,43 patients underwent elective TAAA/DTAA repair using sequential cross-clamping,distal aortic perfusion and CSF drainage.CSF concentration of the markers glial fibrillary acidic protein(GFAP),the light subunit of neurofilament(NFL),and S100B were detected at ten different timepoints between before surgery and 3 days after surgery.The concentration of biochemical marker was compared between spinal cord ischemia and asymptomatic patients.Results Four patients with spinal cord symptoms had significant increase of CSF biomarkers during the postoperative period although no increase during operative period.Compared to asymptomatic patients,4 symptomatic patients have had the mean peak value of GFAP,NFL and S100B increasing 139-fold,4.5-fold and 7.7-fold respectively.The concentration of GFAP 3 hours after surgery was totally separated from that of asymptomatic patients.In two delayed paraplegia cases,the coucentration of biomarkers increased 6 and 19 hours respectively before onset of symptom.By intensive treatment,beth cases had significant improvement in neurological outcomes.Conclusion Biochemical markers in CSF increase too late for intraoperative monitoring of spinal cord ischemia,but GFAP is an excellent marker for predicting postoperative delayed paraplegia.

基金项目:
国家留学基金管理委员会资助(2004835013)
作者简介:
参考文献:
Springer期刊数据库
共找到 2 条记录
服务与反馈:
文章下载】【加入收藏
copyright © 《中国医药》杂志编辑部
地址:北京市朝阳区安贞路2号首都医科大学附属北京安贞医院北楼二层    
电话:010-64456116     传真:010-64428528    邮编:100029
网址:www.chinamedicinej.com     Email: zgyy8888@163.com
当您在使用本网站投稿遇到困难时,请直接将稿件投送到编辑部邮箱zgyy8888@163.com
 京ICP备10041176号-1