间歇性增加脑部逆灌压对深低温停循环脑保护的实验研究  

The Experimental Study of Retrograde Cerebral Perfusion with Intermittent Pressure Augmentation Under Deep Hypothermia Circulatory Arrest for Brain Protection

作　　者：周成斌[1] 肖营凯[1] 杨怡[1] 祁周措[1] 姚丽明[1] 章晓华[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院,广州510080

出　　处：《透析与人工器官》2010年第4期9-12,共4页Chinese Journal of Dialysis and Artificial Organs

基　　金：广东省医学科研基金项目(基金号:WSTJJ20071101420106197201164057)

摘　　要：目的探讨间歇性增加脑部逆灌压对深低温停循环脑保护的作用。方法 15头山羊随机分为深低温停循环组(A组,N=5)、深低温低压逆灌组(L组,N=5)和深低温间歇性高压逆灌组(H组,N=5)。3组动物均经历深低温(15℃～18℃)停循环2 h,期间A组没有脑部逆行灌注,L组和H组经上腔静脉逆行灌注,L组逆灌压控制在20～25 mmHg,H组基础逆灌压为20～25mmHg,每隔10 min用40～45 mmHg的逆灌压灌注5 min,随后恢复至基础逆灌压。分别在体外循环前,深低温停循环前,复温开始,体外循环结束时记录平均动脉压、脑脊液压力和静脉血气值。用眼底镜观察羊的视网膜动静脉充盈情况。留取脑脊液标本,检测S-100含量。结果 3组转流过程中平均动脉压、脑脊液压力、颈静脉血氧饱和度没有显著性差异。3组颈静脉血乳酸值含量总体差异显著,H组低于L组和A组(P<0.05)。配对t检验显示A组和L组体外循环结束后S-100含量明显高于体外循环前水平(P<0.05),但是H组没有显著性变化。A组眼底视网膜血管没有血流,L组视网膜血管不充盈,H组在高流量灌注时视网膜血管充盈。结论间歇性增加脑逆灌压能够增加深低温停循环期间脑组织灌注,减少无氧代谢,对脑组织有保护作用。Objective For brain protection during aortic surgery,we assess whether the retrograde cerebral perfusion with intermittent pressure augmentation under deep hypothermia circulatory arrest could improve brain protection in a goat model,because a high retrograde cerebral perfusion pressure may be required to open cerebral vessels.Methods 15 goats were randomly divided into 3 groups： deep hypothermia circulatory arrest group（A group,N=5）,retrograde cerebral perfusion group with pressure 20-25 mmHg（L group,N=5）,retrograde cerebral perfusion group with intermittent pressure augmentation from 20-25 mmHg to 40-45 mmHg at every 10 min（H group,N=5）.Deep cooling（15℃-18℃） with cardiopulmonary bypass and 2 circulatory arrest for 2 h were performed in 3 groups.The mean blood pressure,cerebrospinal pressure and blood gas values were recorded before bypass and the circulatory arrest,at the beginning of rewarming,at the end of bypass.The levels of S-100 in the cerebrospinal fluid were measured and the retinal vessels were observed.Results There were no significant difference among 3 groups at the aspects of mean blood pressure,cerebrospinal pressure and venous oxygen saturation.The lactate levels were higher in the A group and L group compared with that in the H group（P〈0.05）.The levels of S-100 at the end of bypass were higher in the A group and L group compared with that measured before bypass according to the paired t-test（P〈0.05）,but no significant change was found in the H group.While the retinal vessels were fully distended with blood at a retrograde cerebral perfusion pressure of 45 mmHg in the H group,full distension of the retinal vessels was not observed in the L group and no blood flow in the retinal vessels was found in the A group.Conclusion The retrograde cerebral perfusion with intermittent augmented pressure could improve cerebral perfusion,decrease anaerobic metabolism and provide brain protection during deep hypothermia circulatory arrest.

关 键 词：深低温停循环 脑部逆行灌注 脑保护 

分 类 号：R654.1[医药卫生—外科学]