幼猪体外循环脑灌注血流/压力动物模型的构建  

The construction of the cerebral blood flow/pressure in piglet extracorporeal circulation model

作　　者：姚婧鑫[1] 魏新广 王小龙 李勇男[4] 龙村[1] 林栓同 梁影 姜福清[1] 管玉龙[1] YAO Jingxin;WEI Xinguang;WANG Xiaolong;LI Yongnan;LONG Cun;LIN Shuantong;LIANG Ying;JIANG Fuqing;GUAN Yulong(Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, Chin)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室体外循环科,1000371 [2]武汉亚洲心脏病医院体外循环科 [3]胜利油田中心医院心胸外科 [4]兰州大学第二教学医院心外三科

出　　处：《心肺血管病杂志》2018年第3期235-243,共9页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81170233);教育部留学回国人员科研启动基金(2013-LH01)

摘　　要：目的:本研究拟通过构建幼猪体外循环(CPB)脑灌注血流/压力动物模型,探讨CPB期间动脉血压、灌注流量对脑血流自动调节的影响。方法:20只,幼猪,随机分五组:对照组、高血压高流量组、高血压低流量组、低血压高流量组、低血压低流量组。在CPB开始前10min、CPB开始后10min、升主动脉阻断后30min和升主动脉开放后10min 4个时间点检测血清S100钙结合蛋白B(S100 B)和神经元特异性烯醇化酶(NSE)浓度。免疫组织化学检测大脑海马组织缺氧诱导因子-1α(HIF-1α)、凋亡诱导因子(AIF)和Caspase-3的表达。结果:在升主动脉阻断期间,低流量灌注动物脑灌注流量远远低于高流量组(P=0.009),低流量低血压组r SO2低于其他各组r SO2值(P<0.05),血清S100B水平显著高于高血压低流量组(P=0.032)。海马组织HIF-1α、AIF和Caspase-3的表达无组间差异。结论:低CPB血流可以造成全身和脑灌注不足,脑血管自我调节机制不能抵消低流量造成的脑灌注不足损伤。维持较高的动脉灌注压力,有助于在一定程度上代偿脑灌注不足引起的缺氧状况。Objective： This study was designed to construct one unique piglet model to explore impact of blood flow and arterial pressure on cerebral autoregulation underwent cardiopulmonary bypass（ CPB）. Methods： Four piglets were chosen in control group which underwent thoracotomy without CPB. 16 piglets were divided into 2 groups randomly（ n = 8） ： high CPB blood flow group（ H）; low CPB blood flow group（ L）. According to the mean arterial blood pressure Group H and L were divided into 2 subgroups,high blood pressure subgroups（ H1 and L1） and low blood pressure subgroups（ H2 and L2）. The cerebral blood flow and regional cerebral oxygen saturation（ r SO2） were monitored in real time. Immunohistochemical staining was performed to detect the expression of hypoxia-inducible factor 1-alpha（ HIF-1α）,apoptosis-inducing factor and Caspase-3.Results： During aortic cross-clamping,cerebral blood flow in low CPB group was lower than that in high CPB flow group（ P = 0. 009）. Lowest r SO2 and high serum concentration of S100 B were detected in L2 group. There were no significant differences among expression of HIF-1α,AIF and Caspase-3 in hippocampus neuron. Conclusion： Low CPB blood flow may result in insufficiency of systemic and cerebral perfusion. Cerebral autoregulation cannot compensate the insufficiency of cerebral perfusion caused by low CPB blood flow. High blood pressure may partially offset the adverse effect of low cerebral perfusion.

关 键 词：脑血流自我调节 局部脑血氧饱和度 体外循环 脑灌注 

分 类 号：R54[医药卫生—心血管疾病]