Selective Cerebral Perfusion: Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation
Selective Cerebral Perfusion: Real-Time Evidence of Brain Oxygen and Energy Metabolism Preservation
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DOI：
10.1016/j.athoracsur.2009.03.084
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发表时间：
2009-07-01
影响因子：
4.6
通讯作者：
DiGeronimo, Robert
中科院分区：
文献类型：
--
作者：
Salazar, Jorge D.;Coleman, Ryan D.;DiGeronimo, Robert
背景。深度低温循环停搏（DHCA）通常用于儿童复杂的心脏手术，通常伴有选择性脑灌注（SCP）。关于DHCA合并或不合并SCP对脑代谢的实时影响的资料很少。我们的目标是更好地定义这些影响，重点关注脑氧合和能量代谢。接受体外循环的仔猪分别接受60分钟的18℃DHCA （n = 9）或18℃DHCA合并SCP (n = 8)，采用pH-stat管理。SCP以10 mL/kg/min给药。将脑微透析导管植入大脑皮层，监测细胞缺血和能量储存情况。同时监测脑氧压和颅内压。在有或无SCP的DHCA后，动物在停止体外循环4小时后恢复。与单独DHCA相比，SCP组的脑组织氧张力得以保留（p < 0.01）。深度低温循环骤停与乳酸（p < 0.01）、甘油（p < 0.01）和乳酸/丙酮酸比值（p < 0.001）的显著升高以及能量底物葡萄糖（p < 0.001）和丙酮酸（p < 0.001）的严重耗竭有关。这些变化一直持续到经济复苏。SCP组无明显脑微透析改变。脑氧水平与脑微透析标志物之间有很强的相关性（p < 0.001）。选择性脑灌注保留脑氧合，减轻与DHCA相关的脑代谢紊乱。脑微透析提供与脑组织氧合变化相关的实时代谢反馈。该模型能够进一步研究和改进旨在限制需要复杂心脏手术的儿童脑损伤的策略。（Ann Thorac surgery 2009;88:162-9） (C) 2009年由胸外科学会出版
Background. Deep hypothermic circulatory arrest (DHCA) is commonly used for complex cardiac operations in children, often with selective cerebral perfusion (SCP). Little data exist concerning the real-time effects of DHCA with or without SCP on cerebral metabolism. Our objective was to better define these effects, focusing on brain oxygenation and energy metabolism.Methods. Piglets undergoing cardiopulmonary bypass were assigned to either 60 minutes of DHCA at 18 degrees C (n = 9) or DHCA with SCP at 18 degrees C (n = 8), using pH-stat management. SCP was administered at 10 mL/kg/min. A cerebral microdialysis catheter was implanted into the cortex for monitoring of cellular ischemia and energy stores. Cerebral oxygen tension and intracranial pressure also were monitored. After DHCA with or without SCP, animals were recovered for 4 hours off cardiopulmonary bypass.Results. With SCP, brain oxygen tension was preserved in contrast to DHCA alone (p < 0.01). Deep hypothermic circulatory arrest was associated with marked elevations of lactate (p < 0.01), glycerol (p < 0.01), and the lactate to pyruvate ratio (p < 0.001), as well as profound depletion of the energy substrates glucose (p < 0.001) and pyruvate (p < 0.001). These changes persisted well into recovery. With SCP, no significant cerebral microdialysis changes were observed. A strong correlation was demonstrated between cerebral oxygen levels and cerebral microdialysis markers (p < 0.001).Conclusions. Selective cerebral perfusion preserves cerebral oxygenation and attenuates derangements in cerebral metabolism associated with DHCA. Cerebral microdialysis provides real-time metabolic feedback that correlates with changes in brain tissue oxygenation. This model enables further study and refinement of strategies aiming to limit brain injury in children requiring complex cardiac operations. (Ann Thorac Surg 2009;88:162-9) (C) 2009 by The Society of Thoracic Surgeons