Etiology and Prevention of brain function disorder often cordiovascular surgery

脑功能障碍常进行心血管手术的病因及预防

• 批准号: 12671502
• 负责人: HOKA Sumio
• 金额: $ 2.43万
• 依托单位: KITASATO UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2000
• 资助国家: 日本
• 起止时间: 2000 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-12671502/
• 关键词: Cardiac Surgery; Brain function; Brain damage; athers sclerosis; cardis pulmonary bypass; air embolism; stroke; 脳卒中; 脳機能; 麻酔; 空気寒栓; 脳合併症; 高次脳機能

By searching previous reports concerning the incidence and clinical characteristics of brain function disorder following cardiac and aortic surgeries, we examined to analyze the etiology and preventative measure in brain damage in association with cardiovascular surgery. The incidence of stroke is reported to be 1%-5% after cardiac surgery, whereas that of brain function disorder including cognitive function is 30%-80%. Embolic events, changes in cerebral blood flow, global hypoperfusion, cerebral reperfusion injury, and CPB-triggered whole body inflammatory response represent possible mechanisms. We evaluated our new method for removal of retained air at the termination of cardiopulmonary bypass under the monitoring of end-tidal CO_2 pressure (P_<ET>CO_2), pulmonary arterial pressure (PAP) and transesophageal two-dimensional cardiography (TEE). The Reservoir of the cardiopulmonary bypass was gradually raised to decrease the venous drainage. Accordingly, the right heart began to receiv … More e the venous blood and eject it to the pulmonary artery. The vent existing in the left ventricle or the left atrium then collected any whole blood containing air bubbles that came from the pulmonary circulation. The air bubbles were confirmed to be removed and not to eject from the left ventricle to the systemic circulation by TEE. P_<ET>CO_2 reached 28 ± 4 mmHg during the removal of air, whereas the simultaneous PaCO_2 of 35 ± 6 mmHg (P<0.05). The duration time of removal of air was 9 ± 2 min. The P_<ET>CO_2 and PAP are useful indicators of pulmonary circulation during our procedure for removal of air. P_<ET>CO_2 of 25-30 mmHg and PAP of 90% of the prebypass level have been found to be necessary for the removal of air. It is suggested that our technique for removal of air using P_<ET>CO_2, PAP and TEE enables us to satisfactorily eliminate residual air. However, these methods could not significantly decrease the incidence of brain function disorder following cardiac surgery. From these, We conclude that atherosclerotic and fat embolisms and a decrease in cerebral blood flow during CPB may be important for genesis of brain damage during and after cardiac surgery. Less

通过检索以往有关心脏和主动脉手术后脑功能障碍的发生率和临床特征的报道，我们对心血管手术相关脑损伤的病因和预防措施进行了分析。据报道，心脏手术后中风的发生率为1%-5%，而包括认知功能在内的脑功能障碍的发生率为30%-80%。栓塞事件、脑血流变化、全身低灌注、脑再灌注损伤和CPB引发的全身炎症反应代表了可能的机制。我们在呼气末 CO_2 压力 (P_<ET>CO_2)、肺动脉压 (PAP) 和经食管二维心动图 (TEE) 监测下评估了心肺转流终止时清除滞留空气的新方法。逐渐升高体外循环储液池以减少静脉引流。因此，右心开始接收静脉血并将其喷射到肺动脉。然后，左心室或左心房中存在的排气口收集来自肺循环的含有气泡的全血。通过TEE确认气泡已被去除并且没有从左心室喷射至体循环。排除空气期间P_<ET>CO_2达到28±4mmHg，而同时PaCO_2为35±6mmHg（P<0.05）。除去空气的持续时间为9±2分钟。 P_<ET>CO_2 和 PAP 是我们排气过程中肺循环的有用指标。已发现25-30mmHg的P_<ET>CO_2和90%的预旁路水平的PAP对于去除空气是必要的。这表明我们使用 P_<ET>CO_2、PAP 和 TEE 去除空气的技术使我们能够令人满意地消除残留空气。然而，这些方法并不能显着降低心脏手术后脑功能障碍的发生率。由此，我们得出结论，动脉粥样硬化和脂肪栓塞以及体外循环期间脑血流量的减少可能对于心脏手术期间和术后脑损伤的发生很重要。较少的

项目成果

外 須美夫: "手術侵襲による呼吸・循環ダイナミズム"呼吸循環のダイナミズム. 290-301 (2001)

Sumio Soto：“手术侵入导致的呼吸和循环动力”呼吸循环动力 290-301 (2001)。

Sumio Hoka: "Risk factors in perioperative cardiac events"Circulation Control in Medicine. 21. 405-412 (2000)

Sumio Hoka：“围手术期心脏事件的危险因素”医学循环控制。

外 須美夫: "呼吸・循環のダイナミズム"真興交易医書出版部. 308 (2001)

Sumio Soto：“呼吸和循环的动力”新光贸易医学书籍出版部308（2001）。

Sumio Hoka: "Etiology and risk factors in brain damage following cardiac surgery"Rinsho Masui. 26. 1479-1488 (2002)

Sumio Hoka：“心脏手术后脑损伤的病因学和危险因素”Rinsho Masui。

外 須美夫: "呼吸循環の臨床的重症度評価、術前評価"呼吸循環のダイナミズム. 276-289 (2001)

Sumio Soto：“呼吸循环的临床严重程度评估、术前评估”呼吸循环的动态276-289（2001）。