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深度低体温停循环技术对脑组织代谢的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2006年第5期
页码:
520-523
栏目:
基础研究
出版日期:
2006-10-25

文章信息/Info

Title:
Influence of various deep hypothermic circulatory arrest treatments on brain metabolism
作者:
赵荣; 李彤; 段大为; 赵生涛; 庄晓飞; 蔡振杰
第四军医大学西京医院 全军心血管外科研究所，陕西 西安 710032
Author(s):
ZHAO Rong;  LI Tong;  DUAN Da-wei;  ZHAO Sheng-tao;  ZHUANG Xiao-fei;  CAI Zhen-jie
Institute of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi′an,Shaanxi 710033, China
关键词:
体外循环; 深度低体温停循环; 脑代谢; 逆行脑灌注; 顺行脑灌注
Keywords:
cardiopulmonary bypass;  deep hypothermic circulatory arrest;  brain metabolism;  intermittent antegrade cerebral perfusion;  retrograde cerebral perfusion
分类号:
R318.52
DOI:
-
文献标识码:
A
摘要:
目的 观察深度低体温停循环技术对脑组织代谢及结构的影响。 方法 18只实验犬随机分为3组，深度低体温停循环（deep hypothemic circulatory arrest，DHCA）组，深度低体温停循环结合逆行脑灌注（retrograde cerebral perfusion，RCP）组，深度低体温停循环结合顺行间断脑灌注（intermittent antegrade cerebral perfusion，IACP）组，每组6只。3组动物体外循环开始后将鼻咽温降至18℃，随后停循环90 min；开放循环后逐步复温至鼻咽温到36℃，随后停机。3组动物在停循环前（T1），停循环后45 min（T2）、90 min（T3）及开放循环后15 min（T4）和30 min（T5）分别由股动脉和颈静脉插管留取血液标本进行pH值和乳酸测定。手术结束时取脑海马组织作透射电镜检查，观察脑组织及神经细胞超微结构的变化。 结果 3组动物在停循环前脑组织的pH值无显著差异；停循环后DHCA组和RCP组脑组织pH值比停循环前显著降低，而IACP组pH值无显著差异。3组动物在停循环前动脉血和颈静脉血的乳酸含量无显著差异；停循环后DHCA组和RCP组颈静脉乳酸含量比停循环前显著升高，也比IACP组显著升高；IACP组颈静脉乳酸含量仅在停循环90 min（T3）时比停循环前有显著升高，恢复循环后很快降至停循环前水平。 DHCA组及RCP组神经细胞及细胞核肿胀明显，而IACP组水肿不明显。结论 单纯DHCA时间较长时，脑组织内产生大量乳酸，使脑组织呈酸性状态；RCP对脑组织有一定的保护作用，但易发生脑组织及神经细胞水肿；IACP的脑保护效果较为理想。
Abstract:
AIM To observe the influence of deep hypothermic circulatory arrest treatments on cerebral construction and its metabolism. METHODS Eighteen dogs were randomly divided into three groups of 6 dogs each: the group of deep hypothermic circulatory arrest（DHCA）, the group of DHCA with retrograde cerebral perfusion（RCP）and the group of DHCA with intermittent antegrade cerebral perfusion（IACP）. When their nasopharynx temperature was lowered to 18℃ through cardiopulmonary bypass, deep hypothermic circulatory arrest was started and kept on for 90min. When the circulation reopened, the body temperature was gradually restored until the nasopharynx temperature reached 36℃ and the machine was turned off. Before (T1), and 45 min (T2) and 90 min (T3) after the circulatory arrest, and 15 min (T4) and 30 min (T5) after reopening the circulation, blood samples from all the dogs were obtained by artery and jugular tube inserting for pH and lactate testing. When the surgery was completed, the hippocampus was removed from the brain, and the transmission electron microscope was used to observe the changes in the ultrastructure brain and nerve cells. RESULTS There was no significant difference in pH before circulatory arrest among all the dogs. After circulatory arrest, DHCA and RCP groups showed an significant decrease in brain pH compared with IACP group which showed no significant difference. No significant lactate difference was found in the 3 groups before arrest. After circulatory arrest, DHCA and RCP groups showed a great increase in brain lactate compared with IACP group which showed an increase only at 90 min after circulatory arrest. CONCLUSION Long time DHCA brain produces large amount of lactic acid, which causes brain damage. Although RCP treatment can provide some protection for the brain, it will in some cases lead to dropsy of brain and nerve. IACP treatment has the best brain protection with less dropsy of brain and nerve cells.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2006-03-13.通讯作者：李彤，主任医师，教授，主要从事体外循环过程中心肌和脑保护研究 Tel:（029）84775311Email：Litongberlin@yahoo.com.cn 作者简介：赵荣，主治医师，博士生 Tel：（029）84773898 Email：zhaorong@fmmu.edu.cn
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