乳猪深低温停循环不同流量选择性脑灌注微透析实验研究  

Microdialysis during deep hypothermic circulatory arrest with different flows of selective cerebral perfusion in piglets

作　　者：朱耀斌[1] 李志强[1] 范祥明[1] 刘东海[2] 张伟华[2] 廖秋明[3] Steen Stig 李刚[1] 刘扬[1] 续玉林[1] 张晶[1] 乔晨晖[2] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京100029 [2]郑州大学第一附属医院心外科,郑州450052 [3]瑞典隆德大学医院心胸外科,隆德se22185

出　　处：《中华实用诊断与治疗杂志》2014年第3期220-223,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都医科大学基础-临床科研合作基金项目(13JL26);国家自然科学基金(81371443);北京市自然科学基金(7112046;7122056;7142137;7142049)

摘　　要：目的运用微透析分析技术观察乳猪深低温停循环不同流量选择性脑灌注(antegrade selective cerebral perfusion,ASCP)中神经细胞间液各种物质变化情况。方法 20只健康幼猪麻醉成功后植入微透析针,随机分为对照组5只与实验组15只,对照组为单纯深低温停循环(DHCA组),实验组按不同ASCP流量分为3组各5只,ASCP30组灌注流量为30mL/(kg·min),ASCP50组灌注流量为50mL/(kg·min),ASCP80组灌注流量为80mL/(kg·min)。各组于体外循环前(T1)、降温40min时(T2)、深低温停循环时(T3)、复温40min时(T4)、体外循环后60min时(T5)、体外循环后120min时(T6)6个时间点采集微透析样本,检测氨基酸和能量代谢物质水平,观察变化趋势,评估不同ASCP流量的脑保护效果。结果 DHCA组T3、T4时间点、丙酮酸高于实验组,葡萄糖低于实验组(P<0.05),T3、T4、T5、T6时间点乳酸高于实验组(P均<0.05),T4时间点乳酸/丙酮酸比值、乳酸/葡萄糖比值、甘油高于实验组(P均<0.05);ASCP80组T2~T6时间点乳酸、丙酮酸、甘油、谷氨酸高于ASCP30组和ASCP50组,但差异无统计学意义(P均>0.05)。结论乳猪深低温停循环+ASCP模型深低温体外循环模型中,ASCP维持在较低流量(30~50mL/(kg·min))可起到脑保护作用。Objective To investigate the changes in energy-related metabolites during deep hypothermic circulatory arrest （DHCA） with different flows of antegrade selective cerebral perfusion （ASCP）. Methods Twenty healthy piglets were inserted microdialysis probe into the brain after anesthesia, and were randomly divided into DHCA group （n= 5） and experimental group （n= 15）. DHCA group underwent simple DHCA, while experimental group was redivided into 3 groups according to different flows of ASCP： ASCP30 group with perfusion flow rate of 30 mL / （kg·min）, ASCP50 group with perfusion flow rate of 50 mL / （kg ·min）, and ASCP80 group with perfusion flow rate of 80 mL/（kg·min）. The cerebral extracellular fluids were taken at 6 time points including T1 （before cardiopulmonary bypass）, T2 （40 minutes after cooling）, T3 （60 minutes after DHCA）, T4 （40 minutes after re-warming）, T5 （60 minutes after cardiopulmonary bypass） and T6 （120 minutes after cardiopulmonary bypass）. The concentrations of amine acid and energy-related metabolites were examined, and the tendency was observed to evaluate the brain protective effect of ASCP flow. Results The concentration of pyruvate was significantly higher, and glucose level was lower in DHCA group than those in experimental group at the time points of T3 and T4 （P〈0.05）. The concentration of lactate was significantly higher in DHCA group than that in experimental group at the time points of T3, T4, Ts and T6 （P〈0.05）. The lactate/pyruvate ratio, lactate/glucose ratio and glycerol concentration were significantly higher in DHCA group than those in experiment group at the time point of T4 （P〈0.05）. The concentrations of lactate, pyruvate, glycerol and glutamic acid were higher in ASCP80 group than those in ASCP30 group and ASCP50 group at the time points of Tz, T3, T4 , T5 and T6, but there were no significantly differences between groups （P^0.05）. Conclusions The optimal ASCP flow rate for cerebral protection under

关 键 词：选择性脑灌注 深低温停循环 乳猪 微透析技术 

分 类 号：R654.1[医药卫生—外科学]