Matsuwaka R, Matsuda H, Nakano S, Shirakura R, Kaneko M, Sasako Y, Ohkubo N, Nishimura M, Masai T, Kawashima Y
First Department of Surgery, Osaka University Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Apr;38(4):567-72.
Although selective cerebral perfusion (SCP) might be an useful supportive method for aortic arch surgery, its optimal perfusion criteria has not been established. We studied the relationship between the oxygen saturation of superior vena cava or internal jugular vein (SvO2) and the perfusion hemodynamics during deep hypothermic (DH) SCP in twenty patients (pts) (type A dissection; 10, arch aneurysm; 10). SCP was accomplished by perfusion to the brachiocephalic trunk (BCT) and the left common carotid artery (LCC) using separate pumps. Cardiopulmonary bypass and DHSCP time were 128-312 (222 +/- 43, mean +/- SD) minutes and 25-214 (122 +/- 49) minutes, respectively. The cerebral perfusion pressures (CPP) monitored at the bilateral temporal arteries were 20-60 (47 +/- 9) mmHg and cerebral perfusion flow (CPF) was 0.28-0.7 (0.43 +/- 0.10) L/min/m2. The cerebral perfusion score (CPS) defined as CPP X CPF was 7-39 (20 +/- 8). SvO2 ranged from 79 to 99 (94 +/- 7)%. Two operative deaths were encountered from unrelated causes to SCP in both cases. Cerebral infarction occurred in one patient possibly form prolonged low perfusion with low SvO2. When the safety range of SvO2 in DHSCP was defined as greater than 90%, essential criteria to keep this range was CPP greater than 40 mmHg. In 13 out of 15 pts with SvO2 greater than 90%, CPS were above 15. In conclusion, optimal perfusion criteria for DHSCP was defined as CPP greater than 40 mmHg and CPS(CPP X CPF) greater than 15 considering adequate cerebral oxygen consumption.
尽管选择性脑灌注（SCP）可能是主动脉弓手术中一种有用的支持方法，但其最佳灌注标准尚未确立。我们研究了20例患者（A型夹层动脉瘤10例，主动脉弓动脉瘤10例）在深低温（DH）SCP期间上腔静脉或颈内静脉血氧饱和度（SvO2）与灌注血流动力学之间的关系。通过使用单独的泵向头臂干（BCT）和左颈总动脉（LCC）灌注来实现SCP。体外循环和DH-SCP时间分别为128 - 312（222±43，平均值±标准差）分钟和25 - 214（122±49）分钟。在双侧颞动脉监测的脑灌注压（CPP）为20 - 60（47±9）mmHg，脑灌注流量（CPF）为0.28 - 0.7（0.43±0.10）L/min/m²。定义为CPP×CPF的脑灌注评分（CPS）为7 - 39（20±8）。SvO2范围为79%至99%（94±7）。两例患者均因与SCP无关的原因死亡。1例患者发生脑梗死，可能是由于SvO2低导致长时间低灌注。当将DH-SCP中SvO2的安全范围定义为大于90%时，维持该范围的基本标准是CPP大于40 mmHg。在15例SvO2大于90%的患者中，有13例CPS高于15。总之，考虑到足够的脑氧消耗，DH-SCP的最佳灌注标准定义为CPP大于40 mmHg且CPS（CPP×CPF）大于15。
