Gaudino Mario, Ivascu Natalia, Cushing Melissa, Lau Christopher, Gambardella Ivancarmine, Di Franco Antonino, Ohmes Lucas B, Munjal Monica, Girardi Leonard N
Department of Cardio-Thoracic Surgery, Weill-Cornell University, New York, NY, USA.
Department of Anesthesiology, Weill-Cornell University, New York, NY, USA.
J Thorac Dis. 2018 Mar;10(3):1563-1568. doi: 10.21037/jtd.2018.01.166.
The optimal technique for brain perfusion during circulatory arrest remains controversial. Concern exists that retrograde cerebral perfusion (RCP) via the superior vena cava (SVC) is unable to perfuse the brain. We evaluated whether RCP blood circulates through the brain parenchyma in humans during deep hypothermic circulatory arrest (DHCA). We hypothesized that a significant difference in the levels of S-100β (a protein with very high neuro-sensitivity) between the blood infused in the SVC and the effluent blood returning in the left carotid artery (CA) during RCP, should be regarded as a sign of the circulation of RCP blood through the brain parenchyma.
We enrolled 10 non-consecutive patients undergoing elective arch-surgery using DHCA and RCP. Circulating S-100β levels were measured at baseline and immediately before DHCA. During DHCA and RCP the difference in S-100β between the SVC and the CA was evaluated after 10 minutes of arrest and immediately before resumption of the circulation. S-100β levels were evaluated using enzyme-linked immunosorbent assay (ELISA).
Mean DHCA duration was 22.4±7.9 minutes. Mean S-100β level at baseline was 92.5±54.9 µg/L. After 10 minutes of DHCA the level of S-100β in the CA was significantly higher than in the SVC (936.9±326.3 810.9±307.4 µg/L, P=0.0021). This difference was enhanced at the second DHCA sample (1113.8±334.2 920.5±340.0 µg/L, P=0.0002). There was a statistically significant correlation between the duration of DHCA and the percent difference in S-100β level between the SVC and the CA (Pearson's correlation coefficient =0.902).
RCP is able to perfuse the brain parenchyma in humans during DHCA.
循环停止期间脑灌注的最佳技术仍存在争议。有人担心通过上腔静脉（SVC）进行逆行脑灌注（RCP）无法为大脑供血。我们评估了在深度低温循环停止（DHCA）期间，RCP血液是否在人体脑实质中循环。我们假设，在RCP期间，注入SVC的血液与从左颈动脉（CA）回流的流出血液之间的S-100β（一种具有非常高神经敏感性的蛋白质）水平存在显著差异，应被视为RCP血液在脑实质中循环的迹象。
我们纳入了10例接受使用DHCA和RCP的择期主动脉弓手术的非连续患者。在基线和DHCA即将开始前测量循环S-100β水平。在DHCA和RCP期间，在停止10分钟后以及循环即将恢复前，评估SVC和CA之间S-100β的差异。使用酶联免疫吸附测定（ELISA）评估S-100β水平。
平均DHCA持续时间为22.4±7.9分钟。基线时平均S-100β水平为92.5±54.9μg/L。DHCA 10分钟后，CA中的S-100β水平显著高于SVC（936.9±326.3对810.9±307.4μg/L，P = 0.0021）。在第二个DHCA样本中，这种差异更加明显（1113.8±334.2对920.5±340.0μg/L，P = 0.0002）。DHCA持续时间与SVC和CA之间S-100β水平的百分比差异之间存在统计学显著相关性（Pearson相关系数 = 0.902）。
在DHCA期间，RCP能够为人体脑实质供血。
