Fraser Charles D, Andropoulos Dean B
Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:61-8. doi: 10.1053/j.pcsu.2007.12.005.
Antegrade cerebral perfusion (ACP) is a cardiopulmonary bypass technique that uses special cannulation procedures to perfuse only the brain during neonatal and infant aortic arch reconstruction. It is used in lieu of deep hypothermic circulatory arrest (DHCA), and thus has the theoretical advantage of protecting the brain from hypoxic ischemic injury. Despite this, recent comparative studies have shown no difference in neurodevelopmental outcomes with ACP versus DHCA for neonatal arch repair. This article presents animal and human data demonstrating that ACP flows less than 30 mL/kg/min are inadequate for many patients, and may be the explanation for lack of outcome difference versus DHCA. A technique for ACP, its physiologic basis, and a neuromonitoring strategy are presented, and then the results of an outcome study are reviewed, showing that with ACP technique at higher flows of 50 to 80 mL/kg/min guided by neuromonitoring, periventricular leukomalacia is eliminated on postoperative brain magnetic resonance imaging after neonatal cardiac surgery.
顺行性脑灌注（ACP）是一种体外循环技术，在新生儿和婴儿主动脉弓重建期间，它使用特殊的插管程序仅对大脑进行灌注。它用于替代深低温循环停搏（DHCA），因此在理论上具有保护大脑免受缺氧缺血性损伤的优势。尽管如此，最近的比较研究表明，对于新生儿主动脉弓修复，使用ACP与DHCA在神经发育结局方面并无差异。本文展示了动物和人体数据，表明对于许多患者而言，ACP流量低于30 mL/kg/min是不足的，这可能是与DHCA相比缺乏结局差异的原因。本文介绍了一种ACP技术、其生理基础和一种神经监测策略，然后回顾了一项结局研究的结果，该结果表明，在神经监测引导下，采用50至80 mL/kg/min的较高流量的ACP技术，新生儿心脏手术后的术后脑磁共振成像显示脑室周围白质软化消失。
