不同类型低温体外循环对比的实验研究  

Comparative study of different types of hypothermic cardiopulmonary bypass

作　　者：李磊[1] 徐孟辉 姜文剑[1] 贡鸣[1] 许士俊 王晓龙[1] 刘愚勇[1] 李海洋[1] 关欣亮[1] 张宏家[1] LI Lei;XU Menghui;GONG Ming;JIANG Wenjian;XU Shijun;LIU Yang;WU Zining;DAI Lu;WANG Xiaolong;LIU Yuyong;LI Haiyang;LAN Feng;GUAN Xinliang;ZHANG Hongjia(Department of Cardiovasculer Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科-北京市心肺血管疾病研究所,心血管疾病精准医学北京实验室教育部心血管重塑相关疾病重点实验室,北京大血管疾病诊疗中心,100029

出　　处：《心肺血管病杂志》2020年第2期201-207,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81770466);心血管疾病精准医学北京实验室(PXM2019-014226-000023);国家重点研发计划(2017YFC1308000);北京市医院管理局“登峰”计划专项(DFL20180602)。

摘　　要：目的:本研究旨在比较两种低温循环温度对猪体外循环模型脑损伤的影响。方法:13头猪被随机分配为深低温停循环组(n=5),中低温停循环组(n=5)和对照组(n=3)。实验组于鼻咽温度降至32℃时,阻断升主动脉,灌注心脏停搏液。当鼻咽温降至目标温度时停止体外循环,30 min后,恢复体外循环运行,鼻咽部温度复温至37℃,缓慢脱离体外循环并保持存活24 h。中低温停循环组的操作步骤及时限与深低温停循环组相同。利用BAX,Bcl-2,和Caspase 3免疫组织化学染色及TUNEL检测,近一步研究中低温停循环组与深低温停循环组二者在组织病理学中的差异。并对实验中所得血液样本行S-100B,炎性因子(TNF-α、IL-2及IL-6),关键凝血因子(FXI、FVII)检测。结果:低温停循环组与深低温停循环组在组织病理学分析中并无明显差异。不同温度停循环组脑损伤的血清学指标(Soluble protein-100B)同样未见明显差异。炎性相关因子(TNF-α,IL-2及IL-6)也未见明显区别,但是凝血相关因子(FXI及FVII)显示两组间有明显差异。结论:中低温停循环与深低温停循环相比并未增加脑损伤风险。考虑到深低温停循环对凝血系统显著破坏,中低温停循环相比深低温停循环更加适用于当前外科手术。Objective:The effect of temperature on cerebral injury during hypothermic circulatory arrest has never been specifically studied.This study aimed to compare the effects of two different temperatures used for hypothermic circulatory arrest on the degree of brain injury in pig models.Methods:Thirteen pigs were randomly assigned to 30 minutes of hypothermic circulatory arrest without cerebral perfusion at 15℃(n=5)or at 25℃(n=5)of nasopharyngeal temperature and control group(n=3).Changes in biomarkers of brain injury and capacity for protection against apoptosis were monitored under hypothermic circulatory arrest management at different temperatures in pig models to determine the optimal temperature for hypothermic circulatory arrest.Results:No significant differences in immunohistochemical assay result,including Bax,Bcl-2,and Caspase 3 staining and a TUNEL assay,were observed between the deep and moderate hypothermic circulatory arrest groups.Furthermore,no significant difference was found for biomarkers of brain injury(Soluble protein-100 B)between the 2 experimental groups.Similarly,no significant difference was observed in the trend of changes in inflammatory factors,including TNF-α,IL-2 and IL-6,between these 2 groups(P>0.05).However,in coagulation factors,including FXI and FVII,were different between the deep and moderate hypothermic circulatory arrest groups(P>0.05).Conclusions:Therefore,it can be concluded that moderate hypothermic circulatory arrest does not increase the risk of cerebral injury.Considering the adverse effects of deep hypothermic circulatory arrest on the coagulation system,moderate hypothermic circulatory arrest is more suitable for current clinical practice.

关 键 词：脑损伤 体外循环 低温停循环 免疫组化 

分 类 号：R54[医药卫生—心血管疾病]