University of Wisconsin cerebroplegia in a piglet survival model of circulatory arrest
University of Wisconsin cerebroplegia in a piglet survival model of circulatory arrest
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DOI：
10.1016/0003-4975(95)00876-4
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发表时间：
1995-12-01
影响因子：
4.6
通讯作者：
Jonas, RA
中科院分区：
文献类型：
--
作者：
Forbess, JM;Ibla, JC;Jonas, RA
背景我们机构先前在未成熟仔猪中进行的急性研究表明，在深低温停循环（HCA）期间，给予多剂量威斯康星州大学溶液作为瘫痪剂，可改善脑血流量、细胞内pH值和高能磷酸盐的恢复。为了进一步确定该技术的临床适用性，我们开发了猪心肺转流（CPB）和HCA的存活模型。12只约克郡猪（4 - 5周龄）经右股动脉和右心房进行CPB。将动物冷却至15 ℃的直肠温度，并进行90分钟的HCA。UW组（n = 6）接受单次输注50 mL/kg的4 ℃威斯康星州大学溶液，顺行递送至脑循环。对照组（n = 6）不进行干预。对动物进行再灌注，复温至35 ℃，并从CPB中断奶。使用神经功能缺损评分（0 =正常，500 =脑死亡）和总体性能类别（1 =正常，5 =脑死亡）进行神经功能评估，每隔24小时进行一次，持续5天。在术后第5天，所有脑组织均灌注固定，并检查神经元损伤的组织学证据（0 =正常，5 =严重损伤）。所有动物在术后18至20小时拔管。两组的平均神经功能评分无显著差异。UW组第5天的平均神经功能缺损评分为108分，对照组为68分（p > 0.05）。UW组第5天的总体性能分类为2.8，对照组为2.0（p > 0.05）。3只UW动物但无对照动物出现全身性癫痫发作。组织学检查显示UW动物的损伤更严重，主要是大脑皮层。损伤在UW动物中更广泛，涉及小脑和海马。UW动物的平均组织学损伤评分为3.8，对照组为2.4（p = 0.06）。在未成熟的猪中使用HCA的CPB的临床相关存活模型是可行的。冷UW液作为单剂量脑麻痹剂对CPB和HCA后的未成熟猪脑是不利的，并且可能是有害的。进一步的研究表明，以确定最佳的组成和管理的截瘫解决方案。
Background. Previous acute studies in immature piglets at our institution have demonstrated improved recovery of cerebral blood now, intracellular pH, and high-energy phosphates with the administration of multidose University of Wisconsin solution as cerebroplegia during a period of deep hypothermic circulatory arrest (HCA). In an effort to define further the clinical applicability of this technique, we have developed a survival model of swine cardiopulmonary bypass (CPB) and HCA.Methods. 12 Yorkshire pigs (age 4 to 5 weeks) were placed on CPB via the right femoral artery and right atrium. Animals were cooled to a rectal temperature of 15 degrees C and submitted to 90 minutes of HCA. Group UW (n = 6) received a single infusion of 50 mL/kg of 4 degrees C University of Wisconsin solution delivered antegrade to the cerebral circulation. The control group (n = 6) received no intervention. Animals were reperfused, rewarmed to 35 degrees C, and weaned from CPB. Neurologic assessments using neurologic deficit scoring (0 = normal, 500 = brain death) and overall performance categories (1 = normal, 5 = brain death) were performed at 24-hour intervals for 5 days. On the 5th postoperative day all brains were perfusion-fixed and examined for histologic evidence of neuronal injury (0 = normal, 5 = severe injury).Results. All animals were extubated 18 to 20 hours postoperatively. There was no significant difference between the mean neurologic score of the two groups. The mean day 5 neurologic deficit score was 108 for the UW group and 68 for the control group (p > 0.05). The day 5 overall performance category was 2.8 for the UW group and 2.0 for the control group (p > 0.05). Three of the UW animals but none of the control animals experienced generalized seizures. Histologic examination revealed more severe damage in UW animals, primarily in the cerebral cortex. Injury was more widespread in UW animals, involving cerebellum and hippocampus. The mean histologic injury score was 3.8 for UW animals and 2.4 for the control group (p = 0.06).Conclusions. A clinically relevant survival model of CPB with HCA in immature swine is feasible. Cold UW solution as single-dose cerebroplegia is not beneficial, and may be injurious to the immature swine brain subjected to CPB and HCA. Further studies are indicated to determine optimal composition and administration of cerebroplegic solutions.