Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University, Shanghai, China.
Artif Organs. 2010 Nov;34(11):874-8. doi: 10.1111/j.1525-1594.2010.01110.x.
The objective of this study was to evaluate the effect of pulsatile flow on cerebral blood flow (CBF) in infants with the use of a mild hypothermic cardiopulmonary bypass (CPB). Thirty infants scheduled for open heart surgery were randomized to the pulsatile group (Group P, n = 15) and nonpulsatile group (Group NP, n = 15). In Group P, pulsatile perfusion was applied during the aortic cross-clamping period, whereas nonpulsatile perfusion was used in Group NP. The systolic peak velocity (Vs), the end of diastolic velocity (Vd), the mean velocity (Vm), and the pulsatility index (PI) and the resistance index (RI) of the middle cerebral artery were measured by a transcranial Doppler (TCD) ultrasound after anesthesia (T1; baseline), at the beginning of CPB (T2), 10 min after aortic cross-clamping (T3), 3 min after declamping (T4), at the cessation of CPB (T5), and at the end of the operation (T6). During T3 and T4, the Vs in Group P was significantly higher than in Group NP. However, there were no statistically significant differences between Vd and Vm. The PI and RI in Group P were also higher than those in Group NP (both P < 0.05). During T5, Vd and Vm were higher in Group P (P < 0.05), whereas there was no difference in Vs. Additionally, PI and RI in Group P were significantly lower than those in Group NP (P < 0.05). However, there was no difference during T6. Pulsatile perfusion may increase CBF and decrease cerebral vascular resistance in the early period after mild hypothermic CPB.
本研究旨在评估使用轻度低温心肺转流（CPB）时搏动性血流对婴儿脑血流（CBF）的影响。30 名计划接受心脏直视手术的婴儿被随机分为搏动组（P 组，n=15）和非搏动组（NP 组，n=15）。在 P 组中，在主动脉夹闭期间应用搏动性灌注，而在 NP 组中使用非搏动性灌注。在麻醉后（T1；基线）、CPB 开始时（T2）、主动脉夹闭后 10 分钟（T3）、夹闭后 3 分钟（T4）、CPB 停止时（T5）和手术结束时（T6），通过经颅多普勒（TCD）超声测量大脑中动脉的收缩峰速度（Vs）、舒张末期速度（Vd）、平均速度（Vm）、搏动指数（PI）和阻力指数（RI）。在 T3 和 T4 期间，P 组的 Vs 明显高于 NP 组。然而，Vd 和 Vm 之间没有统计学差异。P 组的 PI 和 RI 也高于 NP 组（均 P<0.05）。在 T5 时，P 组的 Vd 和 Vm 较高（P<0.05），而 Vs 没有差异。此外，P 组的 PI 和 RI 明显低于 NP 组（P<0.05）。然而，在 T6 时没有差异。轻度低温 CPB 后早期搏动性灌注可增加 CBF，降低脑血管阻力。
