Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1215-20. doi: 10.1016/j.ejcts.2011.02.040. Epub 2011 Apr 5.
Regional cerebral perfusion (RCP) has been shown to provide cerebral circulatory support during Norwood procedure. In our institution, high-flow RCP (HFRCP) from the right innominate artery has been induced to keep sufficient cerebral and somatic oxygen delivery via collateral vessels. We studied the effectiveness of HFRCP to regional cerebral and somatic tissue oxygenation in Norwood stage I palliation.
Seventeen patients, who underwent the Norwood procedure, were separated into two groups: group C (n=6) using low-flow RCP and group H (n=11) using HFRCP (mean flow: 54 vs 92mlkg(-1)min(-1), P<0.0001). The mean duration of RCP was 64±10min (range, 49-86min) under the moderate hypothermia. Chlorpromazine (3.0mgkg(-1)) was given to group H patients before and during RCP to increase RCP flow. The mean radial arterial pressure was kept <50mmHg during RCP. To clarify the effectiveness of HFRCP for cerebral and somatic tissue oxygenation, cerebral regional oxygen saturation (rSO(2)) and systemic venous oxygenation (SvO(2)) during RCP were compared between the two groups. Changes in the lactate level before and after RCP, and changes in the blood urea nitrogen (BUN), creatinine, lactate dehydrogenase (LDH), and creatinine kinase (CK) levels before and after surgery, were also compared between the groups.
Mean rSO(2) was 82.9±9.0% in group H and 65.9±10.7% in group C (P<0.05). Mean SvO(2) during RCP was 98.2±4.3% in group H and 85.4±9.7% in group C (P<0.01). During RCP, lactate concentration significantly increased in group C compared with that in group H (P<0.001). After surgery, the LDH and CK levels significantly increased in group C compared with that in group H (P<0.05).
Our study revealed that HFRCP preserved sufficient cerebral and somatic tissue oxygenation during the Norwood procedure. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
已有研究表明，区域脑灌注（RCP）可在 Norwood 手术期间提供脑循环支持。在我们的机构中，通过右侧无名动脉进行高流量 RCP（HFRCP）以通过侧支血管保持足够的脑和体氧输送。我们研究了 HFRCP 在 Norwood Ⅰ期姑息治疗中对区域性脑和体组织氧合的有效性。
17 名接受 Norwood 手术的患者分为两组：使用低流量 RCP 的 C 组（n=6）和使用 HFRCP 的 H 组（n=11）（平均流量：54 与 92mlkg(-1)min(-1)，P<0.0001）。在中度低温下，RCP 的平均持续时间为 64±10min（范围，49-86min）。在 RCP 之前和期间，H 组患者给予氯丙嗪（3.0mgkg(-1)）以增加 RCP 流量。在 RCP 期间将桡动脉平均动脉压保持在<50mmHg。为了阐明 HFRCP 对脑和体组织氧合的有效性，比较了两组患者在 RCP 期间的脑区域性氧饱和度（rSO(2)）和全身静脉氧饱和度（SvO(2)）。还比较了两组患者在 RCP 前后乳酸水平的变化以及手术前后血尿素氮（BUN）、肌酐、乳酸脱氢酶（LDH）和肌酸激酶（CK）水平的变化。
H 组 rSO(2)平均为 82.9±9.0%，C 组为 65.9±10.7%（P<0.05）。H 组 RCP 期间 SvO(2)平均为 98.2±4.3%，C 组为 85.4±9.7%（P<0.01）。在 RCP 期间，C 组的乳酸浓度与 H 组相比显著增加（P<0.001）。手术后，C 组的 LDH 和 CK 水平与 H 组相比显著升高（P<0.05）。
我们的研究表明，HFRCP 在 Norwood 手术期间保持了足够的脑和体组织氧合。侧支血管血管阻力的降低增加了脑和体循环血流量，从而改善了组织氧输送。
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