深低温停循环经右锁骨下动脉持续脑灌注与经上腔静脉逆行脑灌注的比较  

Comparison between continuous cerebral perfusion via right subclavian artery and retrograde cerebral perfusion via superior vena cava during deep hypothermic circulatory arrest

作　　者：徐志云[1] 王为[1] 黄盛东[1] 李凯[1] 

机构地区：[1]第二军医大学长海医院心胸外科,上海200433

出　　处：《中华实验外科杂志》2005年第5期574-576,共3页Chinese Journal of Experimental Surgery

摘　　要：目的比较深低温停循环(DHCA)时经右锁骨下动脉持续脑灌注(RSA)和经上腔静脉逆行脑灌注(SVC)对脑组织的保护效果。方法将36只杂种猫随机分为6组(n=6)建立体外循环(CPB)。1组DHCA45min,无脑灌注;2组DHCA45min,经上腔静脉逆行脑灌注;3组DHCA45min,经右锁骨下动脉持续脑灌注;4组DHCA90min,无脑灌注;5组DHCA90min,经上腔静脉逆行脑灌注;6组DHCA90min,经右锁骨下动脉持续脑灌注。检测各组脑组织超微结构、颈静脉血乳酸含量、脑组织ATP含量和一氧化氮合成酶(NOS)活性。结果DHCA时间相同时,SVC组和RSA组脑组织光镜及电镜下缺血、缺氧改变明显轻于无脑灌注组,颈静脉血乳酸含量和脑组织NOS活性均显著低于无脑灌注组(P<0.05),脑组织ATP含量显著高于无脑灌注组(P<0.05)。DHCA45min后,SVC组和RSA组比较各指标差异无统计学意义。DHCA90min后,RSA组脑组织超微结构缺血、缺氧改变轻于SVC组。且RSA组脑组织ATP含量[(2.02±0.19)μmol/g]显著高于SVC组[(1.72±0.21)μmol/g,P<0.05]。结论长时间深低温停循环时经右锁骨下动脉持续脑灌注比经上腔静脉逆行脑灌注更有利于保护脑组织的氧供需平衡。Objective To compare the protective effects to brain between continuous selective cerebral perfusion via right subclavian artery (RSA) and retrograde cerebral perfusion via superior vena cava (SVC) during deep hypothermic circulatory arrest (DHCA).Methods Thirty-six hybrid cats with both sexes were randomly divided into 6 groups (n=6 in each).Group 1:DHCA for 45 min with no cerebral perfusion;Group 2:DHCA for 45 min with retrograde perfusion via SVC;Group 3:DHCA for 45 min with perfusion via RSA;Group 4:DHCA for 90 min with no cerebral perfusion;Group 5:DHCA for 90 minwith retrograde perfusion via SVC;Group 6:DHCA for 90 min with perfusion via RSA.Ultrastructure of cerebral tissue,lactate content in venous return blood,ATP content in cerebral tissue and activity of nitric oxide synthetase (NOS) in cerebral cells were measured.Results At the same DHCA time,groups with RSA and SVC had milder hypoxia changes of brain ultrastructure than that of groups with no cerebral perfusion.The lactate content and activity of cerebral NOS in groups with RSA and SVC were significantly lower than those in the groups with no cerebral perfusion (P< 0.05), and ATP content in cerebral tissue were significantly higher (P< 0.05). There were no significant differences between SVC group and RSA group in all of the indexes after DHCA for 45 min.After DHCA for 90 min,the ATP content in cerebral tissue in RSA group (2.02± 0.19) μmol/g was significantly higher than that in SVC group [(1.72± 0.21) μmol/g, P< 0.05]. Conclusion For the profit of brain protection,perfusion via RSA is a better way than retrograde perfusion via SVC during long period of DHCA.

关 键 词：上腔静脉逆行脑灌注 右锁骨下动脉 深低温停循环 ATP含量 DHCA 脑组织超微结构 一氧化氮合成酶 乳酸含量 NOS活性 氧供需平衡 RSA 保护效果 体外循环 静脉血 C组 SV 统计学 长时间 缺血 缺氧 

分 类 号：R654[医药卫生—外科学]