Effects of dexmedetomidine combined with mild hypothermia on serum neuron-specific enolase and S100β protein in patients with post cardiac arrest syndrome and prognosis evaluation
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摘要: 目的 探讨右美托咪定联合亚低温对心脏骤停后综合征患者脑保护的作用。方法 选择2018年5月-2020年5月海南省人民医院急诊ICU心脏骤停后复苏成功的51例成年患者为研究对象，分为干预组和对照组。所有患者均给予亚低温治疗、常规生命支持及药物抢救; 同时，干预组在该基础上于复苏成功后6 h内给予右美托咪定[输注速度为0.5 μg/(kg·h)]，至少持续至心肺复苏成功后第3天。2组分别于复苏后1、2、3 d采静脉血，检测血中神经元特异性烯醇化酶(NSE)、S100β蛋白及血乳酸(Lac)水平。同时于复苏后7 d对2组患者进行格拉斯哥预后评分(GOS)，了解脑功能恢复情况，并观察干预组与对照组7 d病死率。结果 2组间S100β蛋白、NSE、Lac在1 d、2 d时间点比较差异无统计学意义(P>0.05)，但在3 d时间点比较均差异有统计学意义(P< 0.05);GOS评分在1 d及7 d时间点比较均差异无统计学意义(P>0.05)。同时干预组中，除S100β蛋白在1 d时间点及GOS评分在1 d时间点比较差异无统计学意义(P>0.05)外，其他观察指标在其他时间点比较均差异有统计学意义(P< 0.05)。对照组中，除GOS评分在1 d时间点比较差异无统计学意义(P>0.05)外，其他观察指标在其他时间点比较均差异有统计学意义(P< 0.05)。结论 右美托咪定联合亚低温用于心脏骤停后复苏成功患者具有一定的脑保护作用。Abstract: Objective To investigate the effect of dexmedetomidine combined with mild hypothermia therapy on brain protection in patients with post-cardiac arrest syndrome.Methods A total of 51 adult patients who were successfully resuscitated after cardiac arrest in the emergency ICU of Hainan General Hospital were enrolled from May 2018 to May 2020. All patients were given mild hypothermia therapy, routine life support and medical rescue. Meanwhile, experimental group was given dexmedetomidine in 6 hours 0.5 μg/(kg· h) to the third day after successful cardiopulmonary resuscitation.In the two groups, venous blood was taken in the first day(1 d), thd second day(2 d), and the third day(3 d) after resuscitation, and the levels of neuron-specific enolase(NSE), S100β protein and blood Lac in the blood were detected. At the same time, the two groups were scored by Glasgow outcome score(GOS) brain function in 7 days after resuscitation to evaluate the recovery of brain function. And the 7-day mortality of experimental group and model group was evaluated.Results There was no significant difference in S100β protein, NSE, and Lac between the two groups at the 1 d and 2 d time points(P>0.05), but there were significant differences at the 3 d time point(P< 0.05).There was no statistically significant difference in GOS scores at 1 d and 7 d time points(P>0.05). At the same time, in the experimental group, there were significant differences in the above indexes except S100β protein and the GOS score at the 1 d time point(P< 0.05). And there were significant differences in other observation indexes in the model group except GOS score at the 1 d time points(P< 0.05)).Conclusion Dexmedetomidine combined with mild hypothermia therapy has a certain brain protection effect in the patients with post cardiopulmonary resuscitation syndrome.
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Key words:
- post-cardiac arrest syndrome /
- dexmedetomidine /
- brain protection /
- neuron-specific enolase /
- S100β /
- lactic acid
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表 1 干预组与对照组S100β蛋白、NSE、Lac、GOS评分比较
X±S 指标 干预组(n=27) 对照组(n=24) t P S100β/(μg·L-1)a) 1d 1.27±2.15 2.72±3.71 -1.68 0.102 2d 2.14±3.60 3.82±5.34 -1.33 0.189 3d 1.07±1.77 6.02±11.05 -2.17 0.040 NSE/(ng·mL-1)b) 1d 112.70±122.23 171.76±117.49 -1.75 0.086 2d 159.40±151.09 221.52±126.83 -1.58 0.121 3d 140.49±145.67 224.92±126.65 -2.20 0.033 Lac/(mmol·L-1)c) 1d 4.25±3.65 6.27±5.11 -1.61 0.115 2d 2.68±1.65 3.27±2.17 -1.11 0.274 3d 1.86±0.93 2.99±2.09 -2.43 0.021 GOS评分/分 1d 2.15±0.46 2.04±0.20 1.10 0.280 7d 2.30±1.07 1.79±0.72 1.99 0.050 注：a)S100β的正常值为≤0.105 μg/L; b)NSE的正常值为≤16.3 ng/mL; c)Lac的正常值为0.6~2.2 mmol/L。 
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表 2 干预组及对照组中死亡与存活患者S100β蛋白、NSE、Lac、GOS评分比较
X±S 指标 干预组 对照组 存活(n=19) 死亡(n=8) t P 存活(n=16) 死亡(n=8) t P S100β/(μg·L-1) 1d 0.77±2.16 2.43±1.71 -1.929 0.065 1.27±2.83 5.62±3.70 -3.202 0.004 2d 0.92±2.61 5.04±4.10 -2.631 0.026 1.99±5.26 7.49±3.36 -2.68 0.014 3d 0.33±0.44 2.81±2.47 -2.822 0.025 1.65±4.01 14.75±15.36 -2.372 0.047 NSE/(ng·mL-1) 1d 44.00±39.92 275.85±90.35 -6.977 < 0.001 122.26±106.50 270.78±65.19 -3.598 0.002 2d 82.30±106.00 342.50±38.08 -6.698 < 0.001 162.29±111.64 340.00±45.67 -5.512 < 0.001 3d 66.49±103.86 316.25±30.15 -6.617 < 0.001 159.88±103.16 355.00±29.76 -7.005 < 0.001 Lac/(mmol·L-1) 1d 2.47±1.30 8.46±4.04 -4.109 0.004 4.06±4.21 10.69±3.77 -3.503 0.009 2d 2.01±1.10 4.26±1.69 -3.467 0.006 2.66±2.09 4.50±1.89 -2.101 0.047 3d 1.40±0.58 2.98±0.55 -6.537 < 0.001 1.95±0.66 5.06±2.47 -3.503 0.009 GOS评分/分 1d 2.21±0.54 2.00±0 1.714 0.104 2.06±0.25 2.00±0 0.699 0.492 7d 3.05±0.91 1.13±0.35 5.749 < 0.001 2.44±0.63 1.00±0 9.139 < 0.001
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