Mori A, Sono J, Nakashima M, Minami K, Okada Y
Jpn Circ J. 1981 Mar;45(3):315-22. doi: 10.1253/jcj.45.315.
Profound hypothermia with core cooling has been considered unsafe as compared with surface cooling because of the induced metabolic acidosis. We carried out studies on mongrel dogs to determine whether or nor conventional cardiopulmonary bypass with pulsatile blood flow for core cooling could replace the bypass with non-pulsatile flow. The recovery time from anoxic damage of the brain due to circulatory arrest was also studied. Cerebral excess lactate (delta XL) (Huckabee) was determined throughout the course of hypothermia. During the cooling period from 30 degrees C down to 20 degrees C, the mean value of delta XL in the pulsatile group was significantly lower than that in the non-pulsatile group (p less than 0.01). After forty minutes of the first total arrest at 20 degrees C, thirty minutes of pulsatile perfusion tended to eliminate the anaerobic metabolism of the brain caused by the first total circulatory arrest (p less than 0.1). Thus, the anaerobic metabolism in the brain appears to be highly suppressed with pulsatile cardiopulmonary bypass during the cooling period. Correction of congenital heart disease in infancy can probably be more safely performed if pulsatile cardiopulmonary bypass for cooling and rewarming is employed instead of the non-pulsatile bypass.
与体表降温相比，由于会引发代谢性酸中毒，深度低温伴核心降温一直被认为是不安全的。我们对杂种狗进行了研究，以确定用于核心降温的带搏动血流的传统体外循环是否能替代非搏动血流的体外循环。还研究了因循环骤停导致脑缺氧损伤后的恢复时间。在整个低温过程中测定了脑内过量乳酸（δXL）（哈克比法）。在从30℃降至20℃的降温期，搏动组的δXL平均值显著低于非搏动组（p<0.01）。在20℃首次完全停循环40分钟后，30分钟的搏动灌注倾向于消除首次完全循环骤停引起的脑无氧代谢（p<0.1）。因此，在降温期，搏动性体外循环似乎能高度抑制脑内的无氧代谢。如果采用搏动性体外循环进行降温和复温，而不是非搏动性体外循环，婴儿期先天性心脏病的矫治可能会更安全地进行。
