Establishment of antegrade selective cerebral perfusion for a brain with old infarction during aortic arch operation

陈旧性梗死主动脉弓手术顺行选择性脑灌注的建立

• 批准号: 13671379
• 负责人: KAZUI Teruhisa
• 金额: $ 2.24万
• 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: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2002
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-13671379/
• 关键词: Aortic arch aneurysm; Antegrade selective cerebral perfusion; pH management; Somatosensory evoked potential; malondialdehyde; pH-stat; α-stat; free radical

Objective : We sought to examine the influence of pH management during antegrade selective cerebral perfusion (ASCP) on brains with or without old infarction in a canine model.Methods : A cerebral infarct canine model was created by means of injection of cylindrical silicon embolus. The dogs had obvious neurological deficits and survived for 4 weeks or more included in the cerebral infarct model. Deep hypothermia with ASCP was performed in 24 mongrel dogs (intact group ; alpha-stat : Group A (n=6), pH-stat : Group B (n=6), infarct group ; alpha-stat : Group C (n=6), pH-stat : Group D (n=6)). The serum concentration of malondialdehyde (MDA) and glutamate were measured, and central conduction time (CCT) and amplitude in somatosensory evoked potentials were assessed during operation. Results : During surgery, in the group C, SmvO_2 was significantly lower (p<0.05) and venous-arterial lactate difference was significant higher (p<0.05) than in the other groups at 28℃ in the cooling phase. The pH-stat group showed significantly higher arterial PaCO_2 and lower pH than those in the alpha-stat group during the period from the cooling 28℃ to the rewarming 28℃ (p<0.05). The other intraoperative parameters did not show any differences among the groups. In the group C, the serum concentration of MDA and glutamate significantly increased and CCT significantly prolonged, and in the group C and group D, the amplitude ratio decreased significantly.Conclusions : pH-stat management, during aortic arch operation with the aid of ASCP, may provide the more effective protection for the brain with old infarction.

目的：我们试图在犬模型中研究顺行选择性脑灌注（ASCP）过程中pH管理对有或没有陈旧性梗塞的犬脑的影响。方法：通过注射圆柱形硅栓来创建脑梗塞犬模型。脑梗死模型中的狗具有明显的神经功能缺损，并且存活了4周或更长时间。在 24 只杂种犬中进行 ASCP 深低温治疗（完整组；α-stat：A 组 (n=6)，pH-stat：B 组 (n=6)，梗塞组；α-stat：C 组 (n=6)，pH-stat：D 组 (n=6)）。术中测定血清丙二醛（MDA）和谷氨酸浓度，并评估中枢传导时间（CCT）和体感诱发电位振幅。结果：手术过程中，28℃降温阶段，C组SmvO_2显着低于其他组（p<0.05），动动乳酸差显着高于其他组（p<0.05）。从降温28℃到复温28℃期间，pH-stat组的动脉PaCO_2显着高于α-stat组，pH-stat显着低于α-stat组（p<0.05）。其他术中参数在各组之间没有显示出任何差异。 C组血清MDA、谷氨酸浓度显着升高，CCT显着延长，C组和D组振幅比显着下降。结论：主动脉弓手术中辅以ASCP的pH-stat管理可以为陈旧性梗死脑部提供更有效的保护。