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Biochemical marker of cerebrospinal ischemia after repair of thoracoabdominal aortic aneurysm
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- Author:
- No author available
- Journal Title:
- CHINA MEDICINE
- Issue:
- 12
- DOI:
- 10.3760/cma.j.issn.1673-4777.2007.12.001
- Key Word:
- 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
Abstract： 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(GEAP)、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组之问的变化.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GEAP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.
- [1]L E, Rosengren,C, Wikkels,L, Hagberg.A sensitive ELISA for glial fibrillary acidic protein: application in CSF of adults.[J].1994,51(2).
- [2]T, Kunihara,N, Shiiya,K, Yasuda.Changes in S100beta protein levels in cerebrospinal fluid after thoracoabdominal aortic operations.[J].2001,122(5).
- [3]Bertil Romner,Tor Ingebrigtsen,Poul Kongstad,etc.Traumatic Brain Damage: Serum S-100 Protein Measurements Related to Neuroradiological Findings[J].2000,17(8).
- [4]Lycke JN,Karlsson JE,Andersen O,etc.Neurofilament protein in cerebrospinal fluid: a potential marker of activity in multiple sclerosis.[J].1998,64(3).
- [5]Satoshi, Matsumoto,Mishiya, Matsumoto,Atsuo, Yamashita,etc.The temporal profile of the reaction of microglia, astrocytes, and macrophages in the delayed onset paraplegia after transient spinal cord ischemia in rabbits.[J].2003,96(6).
- [6]Aarts LP,Schepens MA,Haas FJ,etc.The relationship between evoked potentials and measurements of S-100 protein in cerebrospinal fluid during and after thoracoabdominal aortic aneurysm surgery.[J].1999,30(2).
- [7]Tabayashi K.Spinal cord protection during thoracoabdominal aneurysm repair.[J].2005,35(1).
- [8]E C, Lases,M A, Schepens,F J, Haas,etc.Clinical prospective study of biochemical markers and evoked potentials for identifying adverse neurological outcome after thoracic and thoracoabdominal aortic aneurysm surgery.[J].2005,95(5).