Experimental and Clinical Study of Selective Cerebral Perfusion under Profound Hypothermia

我们调查了以下三项关于体外循环期间脑保护的研究。31-PMRS逆行脑灌注脑保护作用的实验研究我们通过测定三磷酸腺苷（ATP）、磷酸肌酸（PCr）、和使用体内磷-31磁共振波谱（31-P MRS）测定细胞内pH（pHi）。CA组出现严重的细胞内酸中毒和高能磷耗竭。RCP组无ATP耗竭，Pcr和pHi恢复快于CA组。本研究表明，RCP的安全时间CA。新型AMPA受体拮抗剂YM 90 K在中低温停循环时具有脑保护作用，我们研究了新型AMPA受体拮抗剂YM 90 K [6 ...更多信息 - （1H-咪唑-1-基）-7-硝基-2，3（1H，4 H）-喹喔啉二酮盐酸盐]，对中度低体温循环停搏具有脑保护作用。YM 90 K 30℃停搏组Pcr、pHi恢复较未处理组好。证明YM 90 K能改善中低温停循环时脑组织的能量代谢和pHi. S-100蛋白是一种酸性钙结合蛋白，在神经胶质细胞和雪旺细胞中高浓度存在。血清中S-100蛋白升高提示神经元损伤。我们检测了体外循环心脏手术患者血清S-100蛋白水平。无脑血管并发症的患者术后5-10小时血清S-100浓度恢复至术前水平，而脑卒中患者术后24小时血清S-100浓度仍较高。结论：体外循环中及术后S-100蛋白的变化可作为早期发现脑损伤的指标之一。少

We investigated the below three studies for cerebral protection during cardiopulmonary bypass.1. Experimental study of brain protection during retrograde cerebral perfusion using 31-P MRSWe evaluated metabolic state of the brain during retrograde cerebral perfusion (RCP), and compared it with normograde cerebral perfusion (NCP) and circuratory arrest (CA) by measuring the concentration of adenosine triphosphate (ATP), phosphocreatine (PCr), and intracellular pH (pHi) using in vivo phosphorous-31 magnetic resonance spectoscopy (31-P MRS). In the CA group, severe intracellular acidosis and depletion of high-energy phosphorous occured. The RCP group resulted in no depletion of ATP and faster recovery of Pcr and pHi than CA group. This study indicates that RCP prolongs safe duration of CA.2. A novel AMPA receptor antagonist, YM90K, has potential of brain protection during moderately hypothermic circulatory arrest on piglets.We investigated whether a novel AMPA receptor antagonist, YM90K [6 … More -(1H-imidazol-1-yl)-7-nitro-2, 3(1H, 4H)-quinoxalinedione hydrochioride], has potential for cerebral protection with moderately hypoyhermic circuratory arrest. In YM90K-treated 30℃ arrest group, Pcr and pHi recovered better than untreated group. It was conformed that administration of YM90K improved energy metabolism and pHi in cerebral tissue during moderately hypothermic circuratory arrest.3. S-100 protein during cardiopulmonary bypass.S-100 protein is an acidic, calcium binding protein found in high concentration in glial and Schwann cells. The elevation of S-100 protein in serum indicates neuronal damage. We measured S-100 protein level in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). In patients with no cerebral complications, S-100 concen-tration at 5-10 hours after CPB retuned to the level before CPB.However in whom with stroke, the S-100 level remained high 24 hours after. We thought S-100 protein during and after CPB could be one of the markers for early detection of cerebral injury. Less