Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb.
Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb.
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DOI：
10.1097/01.pcc.0000130992.73123.bc
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发表时间：
2004-09-01
期刊：
影响因子：
--
通讯作者：
Hopper, Andrew O
中科院分区：
文献类型：
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作者：
Hunter, Christian J;Blood, Arlin B;Hopper, Andrew O
背景技术背景：关注存在，体外膜肺氧合（ECMO）可能会减少脑血流量（CBF），损害脑自动调节，从而增加神经系统injury.Objective的风险：本研究进行了新生羔羊比较的影响，启动静脉动脉和静脉静脉ECMO对CBF和脑氧输送的激光多普勒血流仪测量。本研究还评估了颈动脉和颈静脉结扎对CBF的影响。设计：CBF、动脉血压、矢状窦压、心率、心输出量、动脉血气和血红蛋白饱和度。在麻醉、仪器和1-2小时的稳定期后，在30分钟的对照期内记录数值，并对颈动脉或颈静脉插管。然后，在静脉动脉或静脉静脉ECMO 1 hr.Main结果：颈动脉结扎导致在60秒内解决的右侧皮质CBF的短暂减少的动物进行了研究。接下来，在60分钟的静脉动脉ECMO期间（流速为100 mL.min（-1）.kg（-1），n = 11），脑血流阻力增加，CBF下降25%，脑氧输送下降30%。自体心输出量和Paco（2）保持恒定。舌动脉的脉动性，代表动脉血流到大脑的脉动性，在整个静脉动脉ECMO中降低。相比之下，在接受ECMO在静脉-静脉模式（n = 7），阻力流，CBF，脑氧输送，和pulsatilitydoesn 't changed.CONCLUSIONS：有没有持续的CBF减少结扎后，无论是颈动脉或颈静脉。静脉动脉ECMO而不是静脉静脉ECMO引起的CBF减少不能归因于血气或血压的变化，但可能与脑阻力血管搏动性降低或循环血管活性化合物水平的差异有关。
BACKGROUND: Concern exists that extracorporeal membrane oxygenation (ECMO) may decrease cerebral blood flow (CBF), impair cerebral autoregulation, and thereby increase the risk of neurologic injury.OBJECTIVE: This study was undertaken in newborn lambs to compare the effects of initiation of venoarterial and venovenous ECMO on CBF and cerebral oxygen delivery as measured by laser-Doppler flowmetry. This study also evaluates the effects of carotid artery and jugular vein ligation on CBF.DESIGN: CBF, arterial blood pressure, sagittal sinus pressure, heart rate, cardiac output, arterial blood gases, and hemoglobin saturation were measured. After anesthesia, instrumentation, and a 1-2 hr stabilization period, values were recorded during a 30-min control period, and the carotid artery or jugular vein was cannulated. The animals were then studied during venoarterial or venovenous ECMO for 1 hr.MAIN RESULTS: Carotid ligation resulted in a transient decrease in right cortex CBF that resolved within 60 secs. Next, during a 60-min period of venoarterial ECMO (flow rate of 100 mL.min(-1).kg(-1), n = 11), cerebral resistance to flow increased, CBF decreased 25%, and cerebral oxygen delivery decreased by 30%. Native cardiac output and Paco(2) remained constant. Pulsatility in the lingual artery, representing the pulsatility of arterial flow to the brain, decreased throughout venoarterial ECMO. In contrast, in those lambs receiving ECMO in the venovenous mode (n = 7), resistance to flow, CBF, cerebral oxygen delivery, and pulsatility did not change.CONCLUSIONS: There was no sustained decrease in CBF after ligation of either the carotid artery or jugular vein. Venoarterial but not venovenous ECMO induced decreases of CBF that could not be attributed to changes in blood gases or blood pressure but that may relate to diminished pulsatility in cerebral resistance vessels or to differences in levels of circulating vasoactive compounds.