最佳顺行性脑灌注流量。
Optimal flow rate for antegrade cerebral perfusion.
机构信息
Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Rm CV116C, Stanford, CA 94305-5407, USA.
出版信息
J Thorac Cardiovasc Surg. 2010 Mar;139(3):530-5; discussion 535. doi: 10.1016/j.jtcvs.2009.12.005.
OBJECTIVE
Antegrade cerebral perfusion is widely used in neonatal heart surgery, yet commonly used flow rates have never been standardized. The objective of this study was to determine the antegrade cerebral perfusion flow rate that most closely matches standard cardiopulmonary bypass conditions.
METHODS
Nine neonatal piglets underwent deep hypothermic cardiopulmonary bypass at a total body flow of 100 mL/kg/min (baseline). Antegrade cerebral perfusion was conducted via innominate artery cannulation at perfusion rates of 10, 30, and 50 mL/kg/min in random order. Cerebral blood flow was measured using fluorescent microspheres. Regional oxygen saturation and cerebral oxygen extraction were monitored.
RESULTS
Cerebral blood flow was as follows: baseline, 60 +/- 17 mL/100 g/min; antegrade cerebral perfusion at 50 mL/kg/min, 56 +/- 17 mL/100 g/min; antegrade cerebral perfusion at 30 mL/kg/min, 36 +/- 9 mL/100 g/min; and antegrade cerebral perfusion at 10 mL/kg/min, 13 +/- 6 mL/100 g/min. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow matched baseline (P = .87), as did regional oxygen saturation (P = .13). Antegrade cerebral perfusion at 30 mL/kg/min provided approximately 60% of baseline cerebral blood flow (P < .002); however, regional oxygen saturation was equal to baseline (P = .93). Antegrade cerebral perfusion at 10 mL/kg/min provided 20% of baseline cerebral blood flow (P < .001) and a lower regional oxygen saturation than baseline (P = .011). Cerebral oxygen extraction at antegrade cerebral perfusion rates of 30 and 50 mL/kg/min was equal to baseline (P = .53, .48) but greater than baseline (P < .0001) at an antegrade cerebral perfusion rate of 10 mL/kg/min. The distributions of cerebral blood flow and regional oxygen saturation were equal in each brain hemisphere at all antegrade cerebral perfusion rates.
CONCLUSION
Cerebral blood flow increased with antegrade cerebral perfusion rate. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow was equal to baseline, but regional oxygen saturation and cerebral oxygen extraction trends suggested more oxygenation than baseline. An antegrade cerebral perfusion rate of 30 mL/kg/min provided only 60% of baseline cerebral blood flow, but cerebral oxygen extraction and regional oxygen saturation were equal to baseline. An antegrade cerebral perfusion rate that closely matches standard cardiopulmonary bypass conditions is between 30 and 50 mL/kg/min.
目的
顺行性脑灌注在新生儿心脏手术中被广泛应用，但常用的流量从未标准化。本研究的目的是确定最接近标准体外循环条件的顺行性脑灌注流量。
方法
9 只新生仔猪在全身流量为 100 mL/kg/min（基线）的情况下进行深低温心肺旁路。顺行性脑灌注通过无名动脉插管以 10、30 和 50 mL/kg/min 的随机顺序进行。使用荧光微球测量脑血流量。监测局部氧饱和度和脑氧摄取。
结果
脑血流量如下：基线时为 60±17 mL/100 g/min；顺行性脑灌注 50 mL/kg/min 时为 56±17 mL/100 g/min；顺行性脑灌注 30 mL/kg/min 时为 36±9 mL/100 g/min；顺行性脑灌注 10 mL/kg/min 时为 13±6 mL/100 g/min。顺行性脑灌注 50 mL/kg/min 时，脑血流量与基线相匹配（P=.87），局部氧饱和度也与基线相匹配（P=.13）。顺行性脑灌注 30 mL/kg/min 提供约 60%的基线脑血流量（P<.002）；然而，局部氧饱和度与基线相同（P=.93）。顺行性脑灌注 10 mL/kg/min 提供基线脑血流量的 20%（P<.001），局部氧饱和度低于基线（P=.011）。顺行性脑灌注率为 30 和 50 mL/kg/min 时，脑氧摄取与基线相等（P=.53，.48），但高于基线（P<.0001），顺行性脑灌注率为 10 mL/kg/min。在所有顺行性脑灌注率下，脑血流和局部氧饱和度的分布在每个大脑半球都相等。
结论
脑血流量随顺行性脑灌注率增加而增加。顺行性脑灌注率为 50 mL/kg/min 时，脑血流量与基线相等，但局部氧饱和度和脑氧摄取趋势表明氧合作用超过基线。顺行性脑灌注率为 30 mL/kg/min 时，仅提供基线脑血流量的 60%，但脑氧摄取和局部氧饱和度与基线相等。与标准体外循环条件最接近的顺行性脑灌注率为 30 至 50 mL/kg/min。
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