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THE EFFICACY OF RETROGRADE CEREBRAL PERFUSION

逆行脑灌注的功效

基本信息

批准号：
02454321
负责人：
TANABE Atuzou
金额：
$ 4.29万
依托单位：
HOKKAIDO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1990
资助国家：
日本
起止时间：
1990 至 1992
项目状态：
已结题

项目摘要

Deep hyporthermic retrograde cerebral perfusion has been employed recently during operation on thoracic aorta. However the efficacy of of the methods are still controversial. Then we estimated the efficacy of retrograde cerebral perfusion (RCP) during circulatory arrest experimentally. Then dogs were used for estimating the efficacy of RCP in normothermic state. Near-infrared spectrophotometory (NIRS) was employed for measurement of cerebral metabolism and oxygenation according to the individual differences (perfusion flow, perfusion pressure, existence of valve in vein, etc.). And evoked cerebral potentials elicited by direct stimulation of the cord was employed for estimating cerebral function. In normothermic state, the dogs were divided into two groups. Group I (n=5) ; simple ciculatory arrest 15 min, reperfusion 60 min, Group II (n=S) ; RCP during ciculatory arrest 15 min, reperfusion 60 min. Results were as follows ; 1) NIRS was useful during RCP for detecting malperfusion of the brain mainly by valve of veins. 2) Evoked cerebral potentials elicited by direct stimulation of the cord was useful in the noisy circumstances compared with them by stimulation of the peripheral nerve (somatosensory cortical evoked potentials). 3) Under controlling cerebral perfusion by NIRS,potentials, latencies, time of their loss and recovering time of evoked potentials were analyzed in groupI and groupII.From this study, we concluded that the efficacy of retrograde cerebral perfusion during circulatory arrest is not enough for maintaining normothermic state. Then RCP might have possibility of cooling brain effectively through veins around it only during deep hypothermic circulatory arrest.

深低温逆行脑灌注近年来已应用于胸主动脉手术。然而，这些方法的有效性仍然存在争议。在此基础上，我们对停循环期间逆行脑灌注（RCP）的效果进行了实验评价。然后在常温状态下用犬评价RCP的疗效。采用近红外光谱仪（NIRS）根据个体差异（灌注流量、灌注压、静脉有无瓣膜等）测定脑代谢和氧合。采用直接刺激脊髓诱发脑电位评价脑功能。在常温状态下，将犬分为两组。Ⅰ组（n=5）;结果表明：1）近红外光谱技术在RCP过程中能有效地检测脑血流灌注异常，主要是通过静脉瓣来检测脑血流灌注异常; 2)与刺激周围神经（体感皮层诱发电位）相比，直接刺激脊髓引起的脑诱发电位在嘈杂的环境中是有用的。3)在NIRS控制脑灌注的条件下，对Ⅰ、Ⅱ组的诱发电位、潜伏期、潜伏期消失时间和潜伏期恢复时间进行分析。因此，只有在深低温停循环时，RCP才有可能通过周围静脉进行有效的脑降温。