Masuda Z, Ishino K, Kato G, Ito A, Asai T, Kuriyama M, Oshima Y, Kawada M, Sano S
Department of Functional Physiology, Biophysiological Science, Okayama University Graduate School of Medicine and Dentistry, Shikata-cho 2-5-1, Okayama, Okayama 700-8558.
J Cardiol. 2001 Sep;38(3):163-8.
To prevent possible neurologic injury after hypothermic circulatory arrest, aortic arch obstruction with cardiac defects is repaired in one stage using isolated cerebral and myocardial perfusion (ICMP). This study investigated serum S-100 protein(S-100) levels in neonates undergoing ICMP.
Between February 2000 and January 2001, 19 neonate patients underwent repair of critical congenital heart defects. Seven of these patients with aortic coarctation(n = 3) or interrupted aortic arch (n = 4) with ventricular septal defect(ICMP group) underwent primary total repair. An arterial cannula was inserted either into the ascending aorta or into a polytetrafluoroethylene graft which was anastomosed to the innominate artery. During arch repair, a cross-clamp was placed between the innominate and left carotid arteries, and an end-to-end arch anastomosis was performed with cerebral perfusion and heart beating. During ICMP the flow was reduced to maintain a radial artery pressure of 30-45 mmHg. The remaining 12 patients underwent complete transposition of great arteries(n = 9) or total anomalous pulmonary venous connection(n = 3) using a cardiopulmonary bypass(CPB) with flow of 150-180 ml/kg/min(control group). Sequential blood samples for S-100 determinations were taken after induction of anesthesia, 30 min after aortic declamping(post-ACC), 30 min after CPB, and 24 hr after CPB.
There were no early and late deaths. Neurologic symptoms were not observed in any patients. Mean ICMP time in ICMP group was 17 +/- 4 min. In all patients, S-100 showed the highest value post-ACC and then declined with time. There were no differences in S-100 between the groups at any other time point.
Selective cerebral perfusion through the innominate artery may be able to maintain brain circulation.
为预防低温循环停搏后可能出现的神经损伤，采用脑和心肌分离灌注（ICMP）技术一期修复合并心脏缺陷的主动脉弓梗阻。本研究调查了接受ICMP的新生儿血清S-100蛋白（S-100）水平。
2000年2月至2001年1月，19例新生儿患者接受了严重先天性心脏缺陷的修复手术。其中7例主动脉缩窄（n = 3）或主动脉弓中断（n = 4）合并室间隔缺损的患者（ICMP组）接受了一期完全修复。动脉插管插入升主动脉或与无名动脉吻合的聚四氟乙烯移植物中。在主动脉弓修复过程中，在无名动脉和左颈动脉之间放置阻断钳，并在脑灌注和心脏跳动的情况下进行端到端的主动脉弓吻合。在ICMP期间，血流减少以维持桡动脉压力在30 - 45 mmHg。其余12例患者采用体外循环（CPB），流量为150 - 180 ml/kg/min，接受大动脉完全转位（n = 9）或完全性肺静脉异位连接（n = 3）手术（对照组）。在麻醉诱导后、主动脉阻断钳松开后30分钟（ACC后）、CPB后30分钟和CPB后24小时采集连续血样测定S-100。
无早期和晚期死亡病例。所有患者均未观察到神经症状。ICMP组的平均ICMP时间为17±4分钟。所有患者中，S-100在ACC后达到最高值，然后随时间下降。在其他任何时间点，两组之间的S-100均无差异。
通过无名动脉进行选择性脑灌注可能能够维持脑循环。
