Protective Effect of Continuous Retrograde Cerebral Perfusion on the Brain During Deep Hypothermic Systemic Circulatory Arrest
Protective Effect of Continuous Retrograde Cerebral Perfusion on the Brain During Deep Hypothermic Systemic Circulatory Arrest
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深低温体循环骤停期间连续逆行脑灌注对脑的保护作用
DOI：
10.1111/j.1540-8191.1994.tb00891.x
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发表时间：
1994
影响因子：
1.6
通讯作者：
K. Matsuyama
中科院分区：
文献类型：
--
作者：
Y. Ueda;S. Miki;Y. Okita;T. Tahata;H. Ogino;T. Sakai;K. Morioka;K. Matsuyama
深低温停循环已广泛用作主动脉弓手术的辅助手段，以保护大脑和其他重要器官。我们于1987年在深低温停循环期间引入了经上腔静脉连续逆行脑灌注，并已在33例患者中使用。连续逆行脑灌注时间范围为10至89分钟（平均40.2±22.5），最低鼻咽温度范围为14至25°C（平均17.4±2.0）。两名动脉瘤破裂患者在术中因出血死亡，另外两名患者连续逆行脑灌注时间分别为24分钟和35分钟，术后1个月因术前肝硬化和败血症死亡。两名患者患有中风。其余27例患者，其中6例接受了60至82分钟的持续逆行脑灌注，没有出现与持续逆行灌注相关的并发症。在连续逆行脑灌注期间，从灌注液和引流回弓血管中获得了 66 对血样。对这些样品的分析表明，氧分压、氧饱和度和氧含量显着降低 (p < 0.001)，二氧化碳 (CO2) 分压和 CO2 含量显着升高 (p < 0.001)。鼻咽部温度以0.01～0.03℃/min的速度逐渐升高，但维持在20℃以下。这些结果反映了这样一个事实：由于氧气和底物的可用性，在连续逆行脑灌注期间大脑的有氧代谢得以维持。该技术为深低温停循环期间的大脑提供了代谢支持的潜力，并延长了主动脉弓手术中深低温停循环的安全时间限制。 （J Card Surg 1994；9：584–595）
Deep hypothermic circulatory arrest has been widely used as an adjunct for surgery of the aortic arch to protect the brain and other vital organs. We introduced the use of continuous retrograde cerebral perfusion via the superior vena cava during deep hypothermic circulatory arrest in 1987 and have used it in 33 patients. Continuous retrograde cerebral perfusion times ranged from 10 to 89 minutes (mean 40.2 ± 22.5), and minimal nasopharyngeal temperatures ranged from 14 to 25°C (mean 17.4 ± 2.0). Two patients with a ruptured aneurysm died during operation due to bleeding and two other patients, with continuous retrograde cerebral perfusion time of 24 and 35 minutes, died 1 month postoperatively due to preoperative liver cirrhosis and sepsis. Two patients suffered from stroke. The remaining 27 patients, including 6 with from 60 to 82 minutes of continuous retrograde cerebral perfusion, had no complications related to continuous retrograde perfusion. During continuous retrograde cerebral perfusion, 66 pairs of blood samples from the perfusate and from the drainage back to the arch vessels were obtained. Analysis of these samples revealed that partial pressure of oxygen, saturation of oxygen, and oxygen content significantly decreased (p < 0.001), and partial pressure of carbon dioxide (CO2) and CO2 content significantly increased (p < 0.001). The nasopharyngeal temperature gradually increased at the rate of 0.01 to 0.03°C/min, but was maintained below 20°C. These results reflect the fact that the aerobic metabolism of the brain is maintained during continuous retrograde cerebral perfusion due to oxygen and substrate availability. This technique offers the potential of metabolic support to the brain during deep hypothermic circulatory arrest and prolongs the safe time limits of deep hypothermic circulatory arrest in surgery of the aortic arch. (J Card Surg 1994;9:584–595)