2020 年第 8 期 第 15 卷

Stanford A型主动脉夹层术后认知功能障碍的危险因素分析及其与神经元特异性烯醇化酶和S-100蛋白的关系

Analysis of risk factors of cognitive dysfunction after Stanford A aortic dissection and its relationship with neuron-specific enolase and S-100 protein

作者：彭小乐1刘愚勇2王晓龙3李海洋2贡鸣3关欣亮3郭东3韩璐2张宏家2

英文作者：Peng Xiaole1 Liu Yuyong2 Wang Xiaolong3 Li Haiyang2 Gong Ming3 Guan Xinliang3 Guo Dong3 Han Lu2 Zhang Hongjia2 

单位：1北京市平谷区医院心外科101200；2首都医科大学附属北京朝阳医院心外科心血管疾病精准医学北京实验室心血管疾病生物医学工程教育部重点实验室100020；3首都医科大学附属北京安贞医院心脏外科100029

英文单位：1Department of Cardiac Surgery Beijing Pinggu Hospital Beijing 101200 China; 2Department of Cardiac Surgery Beijing Chaoyang Hospital Capital Medical University Beijing Laboratory for Cardiovascular Disease Precision Medicine Key Laboratory of Biomedical Engeering for Cardiovascular Disease Research Ministry of Education Beijing 100020 China; 3Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China 

关键词：主动脉夹层；术后认知功能障碍；体外循环；S-100蛋白

英文关键词：

• 摘要：

• 目的 探讨Stanford A型主动脉夹层患者术后认知功能障碍（POCD）的影响因素，并分析血清S-100蛋白和神经元特异性烯醇化酶（NSE）水平与POCD的关系。方法 选取2014年7月至2015年4月首都医科大学附属北京安贞医院收治的97例Stanford A型主动脉夹层患者，均以相同手术方式在低流量顺行性脑灌注下行主动脉夹层手术。术后根据简易智力状态检查量表评分分为POCD组及非POCD组。比较2组一般资料和术前、术中停循环时、复温至36 ℃时、术后4 h、术后24 h的血清S-100蛋白和NSE水平，分析POCD的危险因素。结果 97例患者中21例发生POCD，发生率为21.6%。POCD组患者年龄＞60岁、体外循环时间＞180 min、初中以下学历、女性比例均明显高于非POCD组［57.1%(12/21)比23.7%(18/76)、95.2%(20/21)比56.6%(43/76)、57.1%(12/21)比27.6%(21/76)、47.6%(10/21)比25.0%(19/76)］，差异均有统计学意义（均P＜0.05）。2组间停循环最低温度、停循环时间、术后呼吸机使用时间、重症监护病房停留时间比较差异均无统计学意义（均P＞0.05）。POCD组术中停循环时、复温至36 ℃时、术后4 h、术后24 h的血清S-100蛋白水平均明显高于非POCD组［356（330，379）ng/L比274（225，274）ng/L、355（306，402）ng/L比276（229，362）ng/L、375（317，433）ng/L比287（219，373）ng/L、（391±89）ng/L比（273±90）ng/L］，复温至36 ℃时、术后4 h、术后24 h的血清NSE水平均明显高于非POCD组［4.4（3.5，5.0）μg/L比3.5（3.1，4.6）μg/L、（5.1±1.5）μg/L比（4.1±1.1）μg/L、4.5（3.5，5.9）μg/L比3.6（3.0，4.5）μg/L］，差异均有统计学意义（均P＜0.05）。Logistic回归分析结果 显示，体外循环时间＞180 min和术后24 h S-100蛋白含量高是Stanford A型主动脉夹层患者POCD发生的独立危险因素（比值比=1.026、10.827，95%置信区间：1.011～1.041、1.740～67.386，均P＜0.05）。结论 体外循环时间和术后24 h S-100蛋白含量高是Stanford A型主动脉夹层患者POCD发生的独立危险因素。S-100蛋白对协助诊断POCD有一定的作用。

• Objective To investigate the influential factors of postoperative cognitive dysfunction (POCD) in Stanford type A aortic dissection, and to analyze the relationship between serum S-100 protein and neuron-specific enolase (NSE) levels and POCD.Methods A total of 97 patients with Stanford A aortic dissection admitted to Beijing Anzhen Hospital， Capital Medical University from July 2014 to April 2015 were selected. All patients underwent aortic dissection under low-flow anabolic cerebral perfusion in the same surgical manner. The patients were divided into POCD group and non-POCD group according to the score of the simple mental state examination scale. The serum concentration of S-100 protein and NSE were measured before surgery,during circulation arrest, rewarming to 36 ℃， 4 h and 24h after surgery. Univariate analysis and multivariate Logistic regression analysis were used to find out the risk factors of POCD. Results The incidence of POCD was 21.6%（21/97）. The proportion of patients with age >60 years, extracorporeal circulation time >180 min, junior high school education or lower, females in the POCD group were significantly higher than those in the non-POCD group［57.1%(12/21) vs 23.7%(18/76), 95.2%(20/21) vs 56.6%(43/76), 57.1%(12/21) vs 27.6%(21/76), 47.6%(10/21) vs 25.0%(19/76)］(all P＜0.05). There was no statistically significant difference in the minimum temperature of stop circulation, stop circulation time, postoperative ventilator use time, and stay time in the intensive care unit between the two groups (all P＞0.05). The serum S-100 protein levels of POCD group at the time of intraoperative cessation of circulation， rewarming to 36 ℃, 4 h and 24 h after surgery were significantly higher than those of the non-POCD group［356（330，379）ng/L vs 274（225，274）ng/L, 355（306，402）ng/L vs 276（229，362）ng/L, 375（317，433）ng/L vs 287（219，373）ng/L, （391±89）ng/L vs （273±90）ng/L］, the Serum NSE levels of POCD group at rewarming to 36 ℃, 4 h and 24 h were significantly higher than those of the non-POCD group［4.4（3.5，5.0）μg/L vs 3.5（3.1，4.6）μg/L, （5.1±1.5）μg/L vs （4.1±1.1）μg/L, 4.5（3.5，5.9）μg/L vs 3.6（3.0，4.5）μg/L］ (all P＜0.05). Logistic regression analysis showed that the extracorporeal circulation time＞180 min and the higher protein content of S-100 24 h after surgery were independent risk factors for POCD in Stanford A aortic dissection (odds ratio=1.026, 10.827, 95% confidence interval: 1.011-1.041, 1.740-67.386, all P＜0.05). Conclusion Extracorporeal circulation time and S-100 protein content 24 h after surgery are independent risk factors for POCD in Stanford A aortic dissection. S-100 protein plays a certain role in assisting the diagnosis of POCD.