深低温低流量灌注与降温期血气管理对乳猪脑保护的对照研究  

A comparative study of cerebral protection in blood gas management during cooling versus low-flow perfusion during deep hypothermic cardiopulmonary bypass on piglets

作　　者：苏肇伉[1] 王顺民[1] 白凯[1] 徐志伟[1] 朱德明[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2003年第1期47-49,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：卫生部科研基金资助 ( 96 -2 -2 88)

摘　　要：目的　在深低温体外循环中比较降温期pH稳态血气管理和深低温阶段低流量灌注对脑保护的作用能力。方法　 2 4头乳猪根据不同的体外循环脑保护处理方法分成 4组 ,A组 :深低温停循环、降温期alpha稳态血气管理 ;B组 :深低温停循环、降温期pH稳态血气管理 ;C组 :深低温低流量、降温期alpha稳态血气管理 ;D组 :深低温低流量、降温期pH稳态血气管理。比较不同脑保护方法和体外循环阶段对脑血流 (CBF)、脑氧代谢率 (CMRO2 )、脑乳酸含量、脑水含量和脑电图 (EEG)的影响。结果　B组、D组降温末CBF均高于A组、C组 ;而CMRO2 则低于A组、C组 ;B组、D组降温期EEC平坦波出现早。C组、D组复温期CBF、CMRO2 和EEG恢复好于A组、B组。复温末A组、B组颈内静脉乳酸含量显著高于C组、D组 ,脑水含量组间差异无显著性。结论　深低温体外循环低流量灌注对脑保护的作用能力强于降温期pH稳态血气管理 ,两种方法配合应用具有脑保护的协同作用。Objective: To compare the cerebral protection of blood gas management during cooling versus deep hypothermia low-flow perfusion on piglets. Methods: According to different cerebral protection strategies, 24 piglets were randomly divided into four groups (6 for each group). Group A: deep hypothermia circulatory arrest (DHCA) and alpha stat blood gas management during cooling. Group B: DHCA and pH stat blood gas management during cooling. Group C: deep hypothermia low-flow (DHLF) and alpha stat blood gas management during cooling. Group D: DHLF and pH stat blood gas management during cooling. Cerebral blood flow(CBF), the rate of the cerebral oxygen metabolism (CMRO 2), cerebral lactic acid, brain water content and EEG were compared according to different phases and cerebral protection strategies. Results: At the end of cooling CBF in group B and D were higher than group A and C, while CMRO 2 were lower than group A and C. During cooling, the more rapid EEG depression were found in group B and D. During rewarming the recovery of CBF、CMRO 2 and EEG in group C, and group D were better than group A and B. No significant difference of brain water content were found among four groups. Conclusion: The DHLF is more effective in cerebral protection than pH stat during cooling. pH stat may be additive to DHLF in cerebral protection.

关 键 词：心肺转流术 人工低温 血气管理 脑保护 

分 类 号：R318.52[医药卫生—生物医学工程]