Department of Cardiopulmonary Bypass, Cardiovascular Institute & Fuwai Hospital, Peking Union Medical College, Beijing, China.
Artif Organs. 2012 Sep;36(9):774-9. doi: 10.1111/j.1525-1594.2012.01463.x. Epub 2012 Jul 2.
The aim of this study is to compare cerebral protection using antegrade cerebral perfusion (ACP) with various flow rates during deep hypothermic circulatory arrest (DHCA) in a piglet model. Twenty-three piglets were randomized to five groups: the control group (n = 3), DHCA group (n = 5), ACP25 group (n = 5), ACP50 group (n = 5), and ACP80 group (n = 5). Three control piglets did not undergo operations. Twenty piglets underwent cardiopulmonary bypass (CPB) and DHCA for 60 min at 20°C. ACP was conducted at 0, 25, 50, and 80 mL/kg/min in the DHCA, ACP25, ACP50, and ACP80 group, respectively. Serum S-100B protein and neuron-specific enolase were monitored, and brain tissues were assayed for the activities of caspase-3 and stained for the evidence of apoptotic cellular injury. Rise in serum S-100B level (post-CPB-pre-CPB) in the ACP50 group was significantly lower than that in the ACP80 group (P = 0.001). Caspase-3 levels were significantly elevated in the ACP80 group compared with the ACP25 (P = 0.041) and ACP50 group (P = 0.01), while positive terminal deoxyneucleotidyl transferase-mediated biotin-dUTP nick end labeling reaction scores in the ACP80 group were significantly higher than those in the ACP25 (P = 0.043) and ACP50 group (P = 0.023). Cerebral protection effects of ACP at 25 and 50 mL/kg/min were superior to that of ACP at 80 mL/kg/min as determined by cerebral markers, immunology, and histology.
本研究旨在比较在猪模型中使用不同流量的顺行性脑灌注（ACP）与深低温停循环（DHCA）期间的脑保护效果。23 头小猪被随机分为五组：对照组（n = 3）、DHCA 组（n = 5）、ACP25 组（n = 5）、ACP50 组（n = 5）和 ACP80 组（n = 5）。三组对照组小猪未进行手术。20 头小猪在 20°C 下进行心肺旁路（CPB）和 DHCA 共 60 分钟。在 DHCA、ACP25、ACP50 和 ACP80 组中，ACP 分别以 0、25、50 和 80 mL/kg/min 进行。监测血清 S-100B 蛋白和神经元特异性烯醇化酶，检测 caspase-3 活性，并对凋亡细胞损伤进行染色。ACP50 组血清 S-100B 水平（CPB 后- CPB 前）升高明显低于 ACP80 组（P = 0.001）。与 ACP25 组（P = 0.041）和 ACP50 组（P = 0.01）相比，ACP80 组 caspase-3 水平显著升高，而 ACP80 组阳性末端脱氧核苷酸转移酶介导的生物素-dUTP 缺口末端标记反应评分明显高于 ACP25 组（P = 0.043）和 ACP50 组（P = 0.023）。通过脑标志物、免疫学和组织学检查，发现 25 和 50 mL/kg/min 的 ACP 的脑保护效果优于 80 mL/kg/min 的 ACP。
