间歇性增加脑部逆灌压对深低温停循环脑保护的研究  

Experimental study of retrograde cerebral perfusion with intermittent pressure augmentation under deep hypothermia circulatory arrest for brain protection

作　　者：周成斌[1,2] 肖营凯[1,2] 杨怡[1,3] 祁周措[1,4] 姚丽明[1,4] 章晓华[1,2] 

机构地区：[1]广东省心血管病研究所 [2]广东省人民医院广东省医学科学院心血管外科,广州市510080 [3]广东省人民医院广东省医学科学院眼科,广州市510080 [4]广东省人民医院广东省医学科学院医学研究中心,广州市510080

出　　处：《中国体外循环杂志》2011年第1期24-27,共4页Chinese Journal of Extracorporeal Circulation

基　　金：广东省医学科研基金项目(A2008055)

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）。三组动物均经历深低温（15-18℃）停循环2 h,期间A组未行脑部逆行灌注,L组和H组经上腔静脉逆行灌注,L组逆灌压控制在20-25 mm Hg,H组基础逆灌压为20-25 mm Hg,每隔10 min用40-45 mm Hg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。结果三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差异。三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 To assess whether the retrograde cerebral perfusion（RCP） with intermittent pressure augmentation under deep hypothermia circulatory arrest（DHCA） could improve brain protection in a goat model.METHODS Fifteen goats were randomly divided into 3 groups： DHCA group（A group,N=5）,RCP group with pressure 20-25 mm Hg（L group,N=5）,RCP group with intermittent pressure augmentation from 20-25 mm Hg to 40-45 mm Hg at every 10 minutes（H group,N=5）.Deep cooling（15-18℃） with cardiopulmonary bypass and 2 hours of circulatory arrest were performed in three groups.The mean blood pressure,cerebrospinal pressure and blood gas values were recorded before bypass,before circulatory arrest,at the beginning of re-warming and 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 differences among three 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 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 changes were found in the H group.While the retinal vessels were fully distended with blood at a RCP pressure of 45 mm Hg 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 RCP with intermittent augmented pressure improved cerebral perfusion,decreased anaerobic metabolism and provide brain protection during DHCA.

关 键 词：深低温停循环 脑部逆行灌注 脑保护 山羊 

分 类 号：R654.1[医药卫生—外科学]