Myung Richard J, Petko Matus, Judkins Alexander R, Schears Gregory, Ittenbach Richard F, Waibel Robert J, DeCampli William M
Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, PA 19104, USA.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):1051-6; discussion 1056-7. doi: 10.1016/j.jtcvs.2003.11.008.
Regional low-flow perfusion is an alternative to deep hypothermic circulatory arrest, but whether regional low-flow perfusion improves neurologic outcome after deep hypothermic circulatory arrest in neonates remains unknown. We tested neurologic recovery after regional low-flow perfusion compared with deep hypothermic circulatory arrest in a neonatal piglet model.
Sixteen neonatal piglets underwent cardiopulmonary bypass, were randomized to 90 minutes of deep hypothermic circulatory arrest or regional low-flow perfusion (10 mL.kg(-1).min(-1)) at 18 degrees C, and survived for 1 week. Standardized neurobehavioral scores were obtained on postoperative days 1, 3, and 7 (0 = no deficit to 90 = brain death). Histopathologic scores were determined on the basis of the percentage of injured and apoptotic neurons in the neocortex and hippocampus by hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling (0 = no injury to 4 = diffuse injury). Differences between groups were tested by using the Wilcoxon rank sum test, and results are listed as medians within a range.
There were no significant differences between groups during cardiopulmonary bypass. Postoperative neurobehavioral scores were abnormal in 25% (2/8) of the regional low-flow perfusion animals versus 88% (7/8) of controls. Regional low-flow perfusion animals had significantly less neurologic injury compared with controls on postoperative day 1 (0.00 [range, 0-5] vs 12.5 [range, 0-52]; P <.008). There was a trend for less severe injury in the regional low-flow perfusion group (2.0 [range, 1-4] vs 0.0 [range, 0-50]; P =.08) on hematoxylin and eosin. The degree of apoptosis was significantly less in the regional low-flow perfusion group (0.0 [range, 0-1] vs 2.5 [range, 0-4]; P =.03).
Regional low-flow perfusion decreases neuronal injury and improves early postoperative neurologic function after deep hypothermic circulatory arrest in neonatal piglets.
局部低流量灌注是深低温循环停搏的一种替代方法，但局部低流量灌注能否改善新生儿深低温循环停搏后的神经学转归仍不清楚。我们在新生仔猪模型中比较了局部低流量灌注与深低温循环停搏后的神经功能恢复情况。
16只新生仔猪接受体外循环，随机分为两组，分别在18℃下进行90分钟的深低温循环停搏或局部低流量灌注（10 mL·kg⁻¹·min⁻¹），并存活1周。在术后第1、3和7天获得标准化神经行为评分（0分表示无缺陷，90分表示脑死亡）。组织病理学评分根据苏木精-伊红染色和末端脱氧核苷酸转移酶介导的脱氧尿苷三磷酸生物素缺口末端标记法检测新皮质和海马中受损和凋亡神经元的百分比来确定（0分表示无损伤，4分表示弥漫性损伤）。采用Wilcoxon秩和检验比较两组间差异，结果以范围内的中位数列出。
体外循环期间两组间无显著差异。局部低流量灌注组术后神经行为评分异常的动物占25%（2/8），而对照组为88%（7/8）。与对照组相比，局部低流量灌注组术后第1天的神经损伤明显较轻（0.00[范围，0 - 5]对12.5[范围，0 - 52]；P <.008）。苏木精-伊红染色显示局部低流量灌注组损伤程度有减轻趋势（2.0[范围，1 - 4]对0.0[范围，0 - 50]；P =.08）。局部低流量灌注组的凋亡程度明显较轻（0.0[范围，0 - 1]对2.5[范围，0 - 4]；P =.03）。
局部低流量灌注可减少新生仔猪深低温循环停搏后的神经元损伤，并改善术后早期神经功能。
