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Establishment of antegrade selective cerebral perfusion during aortic arch operation

主动脉弓手术中顺行选择性脑灌注的建立

基本信息

批准号：
11671313
负责人：
KAZUI Teruhisa
金额：
$ 2.18万
依托单位：
Hamamatsu University School of Medicine
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1999
资助国家：
日本
起止时间：
1999 至 2000
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11671313/
关键词：
Thoracic aortic aneurysm Aortic arch aneurysm Total arch replacement Selective cerebral perfusion Cerebral protection 脳梗塞術後脳機能障害頚静脈酸素飽和度 Near infrared spectroscopy

项目摘要

Objective : Patients with old cerebral infarction who undergo aortic arch operation are more susceptible to postoperative neurological dysfunction. To verify such susceptibility, this experimental study was performed. Methods : Cerebral infarct model was created in mongrel dogs by injection of cylindrical silicon embolus through the internal carotid artery. The dogs that had obvious neurological deficits one day later and survived for 4 weeks or more were included in the cerebral infarct model. One month after cerebral infarction was induced, deep hypothermia and selective cerebral perfusion were employed in fourteen mongrel dogs (Infarct group 7, Control group 7). During this procedure, serum glutamate concentration and venous-arterial lactate difference were measured. Histopathological study of the brain was also performed. Results : Changes in venous-arterial lactate difference in both groups were almost similar except in rewarming phase. At 32℃ during rewarming, venous-arterial lactate difference in the Infarct group was significantly higher than that in the Control group (p=0.006). Although pre-cooling concentrations of serum glutamate were similar in both groups, the values in the Infarct group at the end of rewarming were significantly higher than those in the Control group (p=0.046). On histological examinations, the presence of old cerebral infarction with gliosis was confirmed in the Infarct group but neither new cerebral infarction nor destruction of blood brain barrier was found. Conclusion : We have observed an accelerated anaerobic metabolism and an increased extracellular glutamate release in the Infarct group. The brain with old cerebral infarction is more susceptible to ischemia during arch operation.

目的：陈旧性脑梗死患者主动脉弓部手术后更易发生术后神经功能障碍。为了验证这种敏感性，进行了本实验研究。方法：采用犬颈内动脉注射圆柱形硅栓法建立脑梗死模型。1天后有明显神经功能缺损且存活4周或4周以上的犬纳入脑梗死模型。杂种犬14只（脑梗死组7只，对照组7只），于脑梗死后1个月行深低温和选择性脑灌注。在此过程中，血清谷氨酸浓度和静脉-动脉乳酸差进行了测量。还进行了脑组织学研究。结果：除复温期外，两组动、静脉血乳酸差值变化基本相似。复温期间，在32℃时，阻断组的静脉-动脉乳酸差异显著高于对照组（p=0.006）。尽管两组的血清谷氨酸盐的预冷却浓度相似，但复温结束时，复温组的值显著高于对照组（p=0.046）。在组织学检查中，存在陈旧性脑梗死与胶质细胞增生被证实，但既没有新的脑梗死，也没有破坏血脑屏障found. Conclusion：我们已经观察到一个加速无氧代谢和细胞外谷氨酸的释放增加的biloct组。陈旧性脑梗死患者在主动脉弓手术中更易发生脑缺血。