Study For Brain Damage Of Cardopulmonary Bypass In Infants

Objective:To detect the change of Cerebral electric impedance coefficient(CEIC),S100 and neuron-specific enolase (NSE) in serum during the cardopulmonary bypass (CPB) in infants;To explore the brain damage of CPB and provid the clues to study the cerebral protection in CPB further.Methods:1.20 children aged 1～2-year-old who were performed operation for oblique inguinal hernia in our hospital were selected randomly as control group. 40 children in the same age who were diagnosed to be noncyanotic congenital heart disease(ASD,VSD,ASD and VSD,COA,CAVC) were chosen as experimental group. All the cases were excluded from central nervous system disease, surgical trauma, active infection, inflammation, rheumatic fever, hematological system disease, severe hepatic inadequacy and renal inadequacy. Experimental groups are divided into CPB-A (TCPB<90min,Taortic clamping<50min; 20cases) and CPB-B (90min 0.05).2. There was not significantly different among the four indexes of control group, CPB-A and CPB-B group before operation (p>0.05).3. In all groups no significant difference was observed between left and right CEIC in the different time segment (p>0.05).4. There was significantly different in left CEIC(P<0.05), which significantly increased from the beginning to the end in CPB and significantly decreased gradually after operation in the different time segment in CPB-A and CPB-B group, the changes of the right is the same of the left.5. After the beginning of CBP the left CEIC in CPB-B group was significantly increased than that in CPB-A group(p<0.05), the changes of the right is the same of the left between CPB-A and CPB-B.6. S100 and NSE were significantly different in the different time segment in CPB-A and CPB-B group(P<0.05), which significantly increased from the beginning to the end in CPB and significantly decreased gradually after operation in the different time segment; S100 and NSE in CPB-B group were significantly increased that in CPB-A group (P<0.05).7. Left and right CEIC have respectively correlation with S100 and NSE at different periods (r = 0.589, 0.749, 0.599, 0.742; 0.956, 0.703, 0.945,0.706); S100 in serum have postive correlation with NSE in group A ( r =0.800); S100 in serum have postive correlation with NSE in group B ( r =0.8002).8. Detection rate of brain edema in CPB-A is 5% after operation 24h, detection rate of brain edema in CPB-B group is 15% after operation 24h.Conclusions:1. CEIC can be elevated by CPB and the effect is almost the same in the left and right brain; CEIC recovered gradually after CPB. This indicates that brain edema can be induced by CPB and the dgree is postively related to the time of CBP and aortic clamping. Moreover, it also implies that the damage is reversible generally.2. S100 and NSE in serum have a transient rise during the CPB and the degree is also postively concerned with the time of CPB and aortic clamping, which also hints that CPB can lead to brain edema and brain damage.3. CEIC, S100 and NSE in serum reflect brain edema more early than CT and can be regarded as detection indexes of brain damage by CPB.