选择性深低温断血流对心肺等重要器官的影响  

Effects of the cardiopulmonary of selective profound hypothermia and antegrade cerebral perfusion on ischemic brain

作　　者：牛小群[1] 范耀东[2] 高永军[3] 付国平[3] 方绍龙[3] 曹毅[3] 徐蔚[3] 蒲军[3] 

机构地区：[1]昆明医学院第二附属医院呼吸内科,云南昆明650101 [2]昆明医学院第三附属医院,云南昆明650101 [3]昆明医学院第二附属医院神经外科,云南昆明650101

出　　处：《现代预防医学》2012年第5期1196-1199,1206,共5页Modern Preventive Medicine

基　　金：国家自然科学基金项目项目(No30960398);云南省自然科学基金资助项目(No.2009cd178)

摘　　要：目的研究猴脑缺血后行选择性深低温顺行脑灌注对脑、心肺等全身主要器官的影响。方法成年健康恒河猴8只,动物随机分为二组:选择性深低温组(双侧颈总动脉脉夹闭后低温灌流,n=5),常温组(双侧颈总动脉夹闭,n=3)。常温下临时夹闭双侧颈总动脉10min后,选择性深低温组经右颈内动脉灌流2℃林格氏液,右颈内静脉回流,降低脑温至18℃,维持60min后,开放夹闭的颈总动脉及颈内静脉,猴缓慢复苏。于缺血前、后连续监测脑电生理活动,手术中持续监测中心体温、脉搏、呼吸、血压及尿量,术后每天行中枢神经系统功能检查,取脑及心肺等重要脏器行光镜检查。常温组用相同方法灌流37℃林格氏液。结果在8只恒河猴中,选择性深低温组5只猴术中、术后血压、脉搏变化相对稳定,断血流70min后意识恢复并长期生存,术后脑电生理活动恢复到术前水平,术后中枢神经系统功能检查正常,心肺、脑等重要器官组织观察正常;常温组3只猴在灌流60min后未恢复意识,灌流结束1d内死亡,心肺、脑等重要器官可见不同程度异常。结论严重脑缺血后行选择性深低温顺行脑灌注60min是安全可靠的,无严重心肺并发症发生,不会遗留有不可逆性脑缺血损害。OBJECTIVE To investigate effects of the vital organs of selective profound hypothermia and antegrade cerebral perfusion on maca mulattas ischemic brain.METHODS Eight adult monkeys were divided into two groups,selective profound hypothermia group（n = 5）,normothermia group（n = 3）.Bilateral carotid arteries and jugular veins were occluded for 10 minutes at room temperature in eight monkeys.Selective cerebral circulation was established by perfusion of 4℃lingers liquid through right internal carotid artery and flow out of left jugular vein with clip of other carotid arteries in five monkeys.Brain temperature reached 18℃,while the body temperature maintained 32.5±0.58.Cerebral blood recovered after 70 minutes of cerebral ischemia.Other three monkeys had cerebral perfusion of 37℃ lingers liquid with similar methods.The brains and cardiopulmonary were examined by microscopy.EEG was examined before and after operation,the temperature,heart,breath,blood pressure were monitored during the operation,the scales of central nervous system were done every day.RESULTS In selective profound hypothermia group,heart and blood pressure were steady during the operation,and all of them survived forever after filled 70 minutes.The functions of neurological were normal after experiment.The EEG was normal after operation.There were no histology abnormities in brain,cardiopulmonary.The others of normothermia group did not recovery after filled 60 minutes and died,and there were different histology abnormities in brain,cardiopulmonary.CONCLUSION Selective profound hypothemnia and antegrade cerebral perfusion of brain can inhibit ischemic injury and avoid severer cardiopulmonary complications.

关 键 词：猴 脑缺血 选择性低温 心肺 

分 类 号：R33[医药卫生—人体生理学]