摘要
目的比较深低温停循环(DHCA)中不同脑灌注方法下脑组织氧代谢、脑组织温度变化及脑皮质超微结构改变,评价不同灌注方式的脑保护效果。方法健康成年杂种犬15只,随机分为3组。Ⅰ组单纯行DHCA,Ⅱ组DHCA+RCP,Ⅲ组DHCA+SACP。转流降温至鼻咽部温18℃时停循环90min,期间采用不同脑灌注保护技术,然后复温,再灌注90min。结果降温期颈静脉氧饱和度(SjvO2)上升;停循环后各组SjvO2均有不同程度下降,DHCA90min时,Ⅲ组SjvO2明显高于Ⅰ、Ⅱ组,差异显著(P=0.000)。停循环期各组脑组织温度均有缓慢升高,以Ⅰ组最为明显,与Ⅱ、Ⅲ组相比有显著性意义(P=0.000);电镜观察DHCA组的脑组织超微结构损害最重,RCP组次之,SACP组脑组织超微结构基本正常。结论单纯DHCA、DHCA+RCP中脑氧供需不平衡,RCP不能提供足够的脑营养,对DHCA期脑氧代谢无明显改善,但可保持脑部低温,有助于脑保护。SACP能保持脑氧供需平衡,提供充足的氧和营养供应,有效保持脑部低温,有明显的脑保护意义。
Objective To compare the effect of cerebral protection between retrograde cerebral perfnsion （RCP） and selective antegrade cerebral perfusiun （SACP） during deep hypothermic circulatory arrest （DHCA） in canine models. Methods Fifteen healthy adult dogs were randomly divided into 3 groups （n=5）, namely the simple DHCA group （group Ⅰ）, DHCA＋RCP group （group Ⅱ ） and DHCA＋SACP group （group Ⅲ）. Extrocorporeal circulatory was established routinely in the dogs, and DHCA commenced when the nasopharyngeal temperature was reduced to 18 ℃. During DHCA, RCP and SACP were applied in groups Ⅱ and Ⅲ, respectively. All the models were rewarmed after 90 rain of DHCA and the cerebral reperfnsion continued for 90 rain. Cerebral oxygenous metabolic function, cerebral temperature and ultrastructural changes of the neurons were observed in the 3 groups at different time points during the operation. Results The jugular venous oxygen saturation （SjvO2） increased with the temperature reduction, and then decreased after DHCA commencement, showing significant changes at different time points in groups Ⅰ and Ⅱ. SjvO2 in group Ul were significantly higher than that in the other two groups after 90 min of DHCA （P=0.000）. Brain temperature significantly increased in group Ⅰ during DHCA as compared with that in groups Ⅱ and Ⅲ （P=0.000）, but showed no significant difference between the latter two groups （P=0.195）. The ultrastructure of the neurons underwent obvious changes after reperfusion for 30 min in group Ⅰ . In group Ⅱ the neuronal ultrastructure was basically normal at 60 min during DHCA and changed slightly at 90 min, but in group Ul no obvious changes were seen at 90 min during DHCA and only slight changes occurred at 30 min of reperfusion. Conclusions RCP can not supply enough oxygen but can maintain low cerebral temperature, and provide short-term brain protection. DHCA＋SACP provides better brain protection than simple DHCA and DHCA ＋RCP, and has a promising
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2006年第5期644-647,共4页
Journal of Southern Medical University
关键词
深低温停循环
逆行脑灌注
选择性顺行脑灌注
颈静脉血氧饱和度
超微结构
deep hypothermic circulatory arrest
retrograde cerebral perfusion
selective antegrade cerebral perfusion
jugular venous oxygen saturation
ultrastructure
