Cavus Erol, Hoffmann Grischa, Bein Berthold, Scheewe Jens, Meybohm Patrick, Renner Jochen, Scholz Jens, Boening Andreas
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel 24105, Germany.
Paediatr Anaesth. 2009 Aug;19(8):770-8. doi: 10.1111/j.1460-9592.2009.03074.x.
Few data exist regarding antegrade selective cerebral perfusion (ASCP) and its application in newborn and juvenile patients. Clinical data suggest ASCP alone to be superior to deep hypothermic circulatory arrest (DHCA); however, the effects of moderate hypothermia during ASCP on cerebral metabolism in this patient population are still unclear.
After obtaining the approval from animal investigation committee, 16 piglets were randomly assigned to circulatory arrest combined with either ASCP at 27 degrees C or DHCA at 18 degrees C for 90 min. Cerebral oxygen extraction fraction (COEF) from blood as well as cerebral tissue glucose, glycerol, lactate, pyruvate, and the lactate/pyruvate ratio (L/P ratio) by microdialysis were obtained repeatedly.
COEF was lower during cooling and rewarming, respectively, in the DHCA18 group compared to the ASCP27 group (30 +/- 8 vs 56 +/- 13% and 35 +/- 6 vs 58 +/- 7%, respectively). Glucose decreased in both the DHCA18 and ASCP27 groups during the course of cardiopulmonary bypass (CPB), but were higher in the ASCP27 group during ASCP, compared to the DHCA18 group during circulatory arrest (0.7 +/- 0.1 vs 0.2 +/- 0.1 mm.l(-1), P < 0.05). Pyruvate was higher (ASCP27 vs DHCA18: 53 +/- 17 vs 6 +/- 2 microm.l(-1), P < 0.05), and the L/P ratio increased during circulatory arrest in the DHCA18 group, compared to the selective perfusion phase of the ASCP27 group (DHCA18 vs ASCP27: 1891 +/- 1020 vs 70 +/- 28, P < 0.01).
In this piglet model, both cerebral oxygenation and microdialysis findings suggested a depletion of cerebral energy stores during circulatory arrest in the DHCA18 group, compared to selective cerebral perfusion combined with circulatory arrest in the ASCP27 group.
关于顺行性选择性脑灌注（ASCP）及其在新生儿和青少年患者中的应用的数据很少。临床数据表明，单独使用ASCP优于深度低温循环停止（DHCA）；然而，ASCP期间中度低温对该患者群体脑代谢的影响仍不清楚。
在获得动物研究委员会的批准后，将16只仔猪随机分为两组，一组在27℃下进行循环停止联合ASCP，另一组在18℃下进行DHCA，持续90分钟。通过微透析反复获取血液中的脑氧摄取分数（COEF）以及脑组织中的葡萄糖、甘油、乳酸、丙酮酸和乳酸/丙酮酸比值（L/P比值）。
与ASCP27组相比，DHCA18组在降温及复温过程中COEF分别较低（分别为30±8%对56±13%和35±6%对58±7%）。在体外循环（CPB）过程中，DHCA18组和ASCP27组的葡萄糖均降低，但在ASCP期间，ASCP27组的葡萄糖水平高于DHCA18组在循环停止期间的水平（0.7±0.1对0.2±0.1 mmol·L⁻¹，P<0.05）。丙酮酸水平较高（ASCP27组对DHCA18组：53±17对6±2 μmol·L⁻¹，P<0.
