心肺转流中不同血流模式对脑血流自主调节功能的影响  

The effect of different blood flow modes during cardiopulmonary bypass on cerebrovascular autoregulation function:a prospective observational study

作　　者：孙林 徐凌峰[1] 常昕[1] 徐花 施丹 郭震 Sun Lin;Xu Lingfeng;Chang Xin;Xu Hua;Shi Dan;Guo Zhen(Department of Cardiac Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院心脏外科,上海200030

出　　处：《中国体外循环杂志》2022年第5期267-271,280,共6页Chinese Journal of Extracorporeal Circulation

基　　金：上海市科委医学引导类资助项目(17411971300)。

摘　　要：目的 前瞻性观察研究心肺转流中搏动血流和平流血流对脑血流自主调节(CA)功能的影响。方法 选取本院2019年6月至2019年12月单纯心脏二尖瓣病变行瓣膜置换或成形手术的患者20例。主动脉阻断后先后进行平流和搏动灌注,通过平均压和脑氧饱和度相关性指数、CA功能完整的最低血压阈值(LLA)的自身前后对照,研究平流和搏动灌注模式对CA功能的影响。结果 平流模式下,8例患者(40%)丧失了完整的CA功能。经血压滴定后平流灌注CA完整的平均压下限(NP_(LLA))为(55.05±11.64)mmHg。转换为搏动灌注后,19例患者CA完整的搏动平均压下限(PP_(LLA))均降低,搏动灌注组PP_(LLA)更低(48.05±11.64)mmHg vs.(55.05±12.31)mmHg。结论 CA功能完整的最低平均压阈值个体间差异显著,搏动灌注可在更低的血压下维持完整的CA功能。Objective To analyze the effect of pulsatile and non-pulsatile blood flow on cerebral autoregulation(CA) function.Methods From June 2019 to December 2019,20 patients with mitral stenosis or regurgitation who underwent valvular replacement or valvuloplasty were selected.After aortic cross-clamping,the radial artery mean pressure(MAP) and regional cerebral oxygen saturation(rSCO_(2)) were inputted in data analysis system for the generation of cerebral oxygen saturation index,which were analyzed by Pearson correlation analysis.The low limited mean arterial pressure(LLA) maintaining intact cerebral autoregulation function were compared between different blood flow patterns.Results CA function was lost in 8 patients(40%) in the non-pulsatile mode.The lower mean pressure limit(NP_(LLA)) of intact CA after blood pressure titration in non-pulsatile perfusion was 55.05±11.64 mmHg.After conversion to pulsatile perfusion,PP_(LLA) of intact CA decreased in all 19 patients,with lower PP_(LLA )than non-pulsatile perfusion(48.05±11.64 mmHg vs.55.05±12.31 mmHg).Conclusion The minimum mean pressure threshold for intact CA varies significantly between individuals,and pulsatile perfusion can maintain intact CA function at lower arterial pressures.

关 键 词：体外循环 搏动血流 脑血流自主调节 

分 类 号：R654.2[医药卫生—外科学]