体外循环会增加血脑屏障的通透性。
Cardiopulmonary bypass increases permeability of the blood-cerebrospinal fluid barrier.
机构信息
Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC 20010, USA.
出版信息
Ann Thorac Surg. 2010 Jan;89(1):187-94. doi: 10.1016/j.athoracsur.2009.09.030.
BACKGROUND
The integrity of the blood-cerebrospinal fluid (CSF) barrier during cardiopulmonary bypass (CPB) with hypothermic circulatory arrest (HCA) has not been systematically studied, especially in children. We tested the hypothesis that the blood-CSF barrier is disrupted by CPB.
METHODS
The study randomized 25 piglets (mean weight, 11 kg) to five groups (5 per group): anesthesia alone (control); CPB at 37 degrees C with full-flow (FF); CPB at 25 degrees C with very low flow (LF); and HCA at 15 degrees C and 25 degrees C. pH-stat strategy was applied during CPB. An epidural catheter was inserted into the cisterna magna for collection of CSF. CSF and blood samples were collected at seven points: after induction of anesthesia (baseline), at 10, 50 and 115 minutes after start of CPB, just before the end of CPB, and at 30 and 120 minutes after CPB. Albumin levels in CSF and plasma were measured to assess blood-CSF barrier integrity and the albumin ratio (CSF/plasma) was calculated (Q(Alb)).
RESULTS
In both HCA groups, the Q(Alb) was significantly higher than in the control and 37 degrees C FF groups (all p < 0.05), whereas Q(Alb) in the 37 degrees C group was not significantly different vs control.
CONCLUSIONS
The blood-CSF barrier is impaired by CPB with 1 hour of 15 degrees C or 25 degrees C HCA. Further investigations are needed to understand the behavior of the blood-CSF barrier during CPB and its role in neuroprotection.
背景
体外循环（CPB）低温循环阻断（HCA）期间血脑屏障的完整性尚未得到系统研究，尤其是在儿童中。我们假设 CPB 会破坏血脑屏障。
方法
该研究将 25 头小猪（平均体重 11 公斤）随机分为五组（每组 5 头）：单独麻醉（对照）；CPB 温度为 37°C 且流量充足（FF）；CPB 温度为 25°C 且流量极低（LF）；以及 HCA 温度为 15°C 和 25°C。CPB 期间应用 pH -stat 策略。硬膜外导管插入枕骨大孔以收集脑脊液。CPB 开始后 7 个时间点采集 CSF 和血液样本：麻醉诱导后（基线）、CPB 开始后 10、50 和 115 分钟、CPB 结束前、CPB 后 30 和 120 分钟。测量 CSF 和血浆中的白蛋白水平以评估血脑屏障的完整性，并计算白蛋白比值（CSF/血浆）（Q(Alb)）。
结果
在两个 HCA 组中，Q(Alb)均明显高于对照组和 37°C FF 组（均 p < 0.05），而 37°C 组的 Q(Alb)与对照组无显著差异。
结论
CPB 后 1 小时 15°C 或 25°C HCA 会损害血脑屏障。需要进一步研究以了解 CPB 期间血脑屏障的行为及其在神经保护中的作用。
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