Tenri Hospital and Tenri Institute of Medical Research, Tenri, Nara, Japan; Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ann Cardiothorac Surg. 2013 May;2(3):316-25. doi: 10.3978/j.issn.2225-319X.2013.01.02.
Brain protection during aortic arch surgery by perfusing cold oxygenated blood into the superior vena cava was first reported by Lemole et al. In 1990 Ueda and associates first described the routine use of continuous retrograde cerebral perfusion (RCP) in thoracic aortic surgery for the purpose of cerebral protection during the interval of obligatory interruption of anterograde cerebral flow. The beneficial effects of RCP may be its ability to sustain brain hypothermia during hypothermic circulatory arrest (HCA) and removal of embolic material from the arterial circulation of the brain. RCP can offer effective brain protection during HCA for about 40 to 60 minutes. Animal experiments revealed that RCP provided inadequate cerebral perfusion and that neurological recovery was improved with selective antegrade cerebral perfusion (ACP), however, both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates by risk-adjusted and case-matched comparative study. RCP still remains a valuable adjunct for brain protection during aortic arch repair in particular pathologies and patients.
1990 年，Ueda 及其同事首次描述了在胸主动脉手术中常规使用持续逆行性脑灌注（RCP），以在必须中断顺行性脑血流的间隔期间保护大脑。RCP 的有益效果可能与其在低温循环停止（HCA）期间维持大脑低温的能力以及从大脑动脉循环中清除栓子物质的能力有关。RCP 可以在 HCA 期间提供约 40 至 60 分钟的有效脑保护。动物实验表明，RCP 提供的脑灌注不足，选择性顺行性脑灌注（ACP）可改善神经恢复，但通过风险调整和病例匹配的比较研究，RCP 和 ACP 在死亡率和中风率方面提供了可比的临床结果。在特定的病理和患者中，RCP 仍然是主动脉弓修复时脑保护的有价值的辅助手段。
