不同血气管理与红细胞压积在深低温停循环中对乳猪脑损伤的影响  

Effect of Different Gases and Hematocrits on Cerebral Injury During Deep Hypothermic Circulatory Arrest in Piglet

作　　者：黄继红[1] 苏肇伉[1] 白凯[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心胸心外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2005年第2期93-97,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的用近红外分光仪(NIRS)观察不同的血气管理和红细胞压积(HCT)对乳猪深低温停循环(DHCA)中脑损伤的影响。方法将24只乳猪根据DHCA期间所采用不同的血气管理和HCT分为4组。A组术中HCT0.25～0.30,降温期pH稳态管理血气,其余各期采用alpha稳态管理血气;B组术中HCT0.25～0.30,alpha稳态管理血气;C组术中HCT0.20～0.25,降温期pH稳态管理血气;D组术中HCT0.20～0.25,alpha稳态管理血气。用NIRS连续监测脑氧合情况,术后6h脑组织固定于甲醛中,并进行组织学评分判断脑损伤程度。结果NIRS指标中,D组脑氧合血红蛋白(HbO2)和总血红蛋白(HbT)在降温期明显低于A组和B组(P<0.05),A组DHCA期间HbO2最低点持续时间(HbO2-NT)明显短。所有HbO2-NT小于25min的乳猪均无脑组织损伤的病理改变。结论DHCA期间采用pH稳态联合高HCT能减轻术后脑损伤。Objective To investigate different gases and hematocrits on cerebral injury during deep hypothermic circulatory arrest (DHCA) in a piglet model including monitoring by near-infrared spectroscopy (NIRS). Methods ~Twenty-four piglets were assigned to 4 groups with respect to different blood gas and hematocrit during DHCA. Group A: hematocrit was maintained between 0.25 to 0.30, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group B: hematocrit was maintained between 0.25 to 0.30 and alpha stat strategy; group C: hematocrit was maintained between 0.20 to 0.25, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group D: hematocrit was maintained between 0.20 to 0.25 and alpha stat strategy. Cerebral oxygenations of piglets were monitored continuously by NIRS. The brain was fixed in situ at 6 hours after operation and a histological score for neurological injury was assessed. Results Oxygenated hemoglobin (HbO_2) and total hemoglobin (HbT) signals detected by NIRS were significantly lower in group D than those in group A and group B during cooling (P<0.05). Oxygenated hemoglobin nadir time was significantly shorter in group A(P<0.05). All piglets with oxygenated hemoglobin signal nadir time less than 25 minutes were free from histological evidence of brain injury. Conclusion Combination of pH-stat strategy and higher hematocrit reduces neurological injury after DHCA.

关 键 词：深低温停循环 红细胞压积 血气管理 乳猪 alpha 近红外分光仪 DHCA pH稳态 氧合血红蛋白 NIRS HCT 脑损伤程度 脑组织损伤 降温期 中脑损伤 连续监测 组织固定 持续时间 HbO2 病理改变 后脑损伤 术中 期间 脑氧合 组织学 

分 类 号：R654.1[医药卫生—外科学] R446.11[医药卫生—临床医学]