Gao Yong, Zou Xiao-ming, Wang Wu-jun, Liu Gao-wang, Gu Miao-ning
Department of Thoracic and Cardiac Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2006 May;26(5):644-7.
To compare the effect of cerebral protection between retrograde cerebral perfusion (RCP) and selective antegrade cerebral perfusion (SACP) during deep hypothermic circulatory arrest (DHCA) in canine models.
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 degrees C. During DHCA, RCP and SACP were applied in groups II and III, respectively. All the models were rewarmed after 90 min of DHCA and the cerebral reperfusion continued for 90 min. 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.
The jugular venous oxygen saturation (SjvO(2)) increased with the temperature reduction, and then decreased after DHCA commencement, showing significant changes at different time points in groups I and II. SjvO(2) in group III 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 III no obvious changes were seen at 90 min during DHCA and only slight changes occurred at 30 min of reperfusion.
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 prospect in cardiac surgery.
比较犬深低温停循环（DHCA）期间逆行脑灌注（RCP）和选择性顺行脑灌注（SACP）的脑保护效果。
15只健康成年犬随机分为3组（n = 5），即单纯DHCA组（I组）、DHCA + RCP组（II组）和DHCA + SACP组（III组）。常规建立犬体外循环，当鼻咽温度降至18℃时开始DHCA。在DHCA期间，II组和III组分别应用RCP和SACP。所有模型在DHCA 90分钟后复温，并继续脑灌注90分钟。观察手术过程中不同时间点3组的脑氧代谢功能、脑温及神经元超微结构变化。
颈静脉血氧饱和度（SjvO₂）随体温降低而升高，DHCA开始后降低，I组和II组在不同时间点有显著变化。DHCA 90分钟后，III组的SjvO₂显著高于其他两组（P = 0.000）。与II组和III组相比，I组在DHCA期间脑温显著升高（P = 0.000），但后两组之间无显著差异（P = 0.195）。I组再灌注3０分钟后神经元超微结构发生明显变化。II组在DHCA 60分钟时神经元超微结构基本正常，9０分钟时略有变化，而III组在DHCA 9０分钟时无明显变化，再灌注3０分钟时仅有轻微变化。
RCP不能提供足够的氧，但能维持较低的脑温，提供短期脑保护。DHCA + SACP比单纯DHCA和DHCA + RCP提供更好的脑保护，在心脏手术中有广阔的应用前景。
