A P-31-MAGNETIC RESONANCE STUDY OF ANTEGRADE AND RETROGRADE CEREBRAL PERFUSION DURING AORTIC-ARCH SURGERY IN PIGS
A P-31-MAGNETIC RESONANCE STUDY OF ANTEGRADE AND RETROGRADE CEREBRAL PERFUSION DURING AORTIC-ARCH SURGERY IN PIGS
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DOI：
10.1016/s0022-5223(05)80009-1
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发表时间：
1995-07-01
影响因子：
6
通讯作者：
SALERNO, TA
中科院分区：
文献类型：
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作者：
FILGUEIRAS, CL;WINSBORROW, B;SALERNO, TA
为了评价低温停循环对脑代谢的影响，我们使用P-31磁共振波谱法监测猪脑缺血2小时和再灌注1小时期间的脑代谢物。将28头猪分为5组，麻醉组（n = 5）和低温体外循环组（n = 5）作为对照。停循环组（n = 6）、顺行灌注组（n = 6）和逆行灌注组（n = 6），转流量为60 ~ 100 ml。kg（-1）。最小值（-1）。在顺行组中，通过颈动脉以180至200 ml的血流量灌注脑。min（-1）。逆行组经上级腔静脉以300 ~ 500 ml的流量灌注脑。min（-1）。麻醉组和低温心肺转流组的细胞内pH值分别为7.1 +/- 0.1和7.3 +/- 0.1。在停循环组中，细胞内pH值下降至6.2 +/- 0.1，并且没有恢复到其初始值再灌注期间（7.0 +/- 0.1）（与相应时间从对照组获得的值相比p < 0.05），无机磷酸盐在再灌注期间没有恢复到其初始水平。在该组的三只动物中，高能磷酸盐的水平，三磷酸腺苷和磷酸肌酸部分恢复，但未达到停搏前观察到的水平。逆行灌注组在停循环时，脑内pH值降至6.4 ± 0.1，再灌注时恢复正常（7.1 +/- 0.1），高能磷酸盐在再灌注期间也恢复到其初始水平，这些研究表明，深低温停循环与顺行脑灌注提供了最好的脑保护的选项研究。
To evaluate the effect of hypothermic circulatory arrest on brain metabolism, we used P-31-magnetic resonance spectroscopy to monitor brain metabolites in pigs during 2 hours of ischemia and 1 hour of reperfusion. Twenty-eight pigs were divided into five groups, Anesthesia (n = 5) and hypothermic cardiopulmonary bypass groups (n = 5) served as controls, In the circulatory arrest (n = 6), antegrade perfusion (n = 6), and retrograde (n = 6) brain perfusion groups, the bypass flow rate was 60 to 100 ml . kg(-1). min(-1). In the antegrade group, the brain was perfused via the carotid arteries at a blood flow rate of 180 to 200 ml . min(-1) during circulatory arrest at 15 degrees C. In the retrograde group, the brain was perfused through the superior vena cava at a flow rate of 300 to 500 ml . min(-1) during circulatory arrest at 15 degrees C. The intracellular pH was 7.1 +/- 0.1 and 7.3 +/- 0.1 in the anesthesia and hypothermic cardiopulmonary bypass groups, respectively, In the circulatory arrest group, the intracellular pH decreased to 6.2 +/- 0.1 and did not recover to its initial value (7.0 +/- 0.1) during reperfusion (p < 0.05 compared with the value obtained from the control groups at the corresponding time), Inorganic phosphate did not return to its initial level during reperfusion, In three animals in this group, levels of high-energy phosphates, adenosine triphosphate and phosphocreatine, recovered partially but did not reach the levels observed before arrest. In the group receiving antegrade perfusion, cerebral metabolites and intracellular pH were unchanged throughout the protocol, During circulatory arrest in the retrograde perfusion group the intracellular pH decreased to 6.4 +/- 0.1 and recovered fully during reperfusion (7.1 +/- 0.1), High-energy phosphates also returned to their initial levels during reperfusion, These studies show that deep hypothermic circulatory arrest with antegrade brain perfusion provides the best brain protection of the options investigated.