Sakahashi H, Hashimoto A, Aomi S, Tokunaga H, Koyanagi T, Imamaki M, Tagusari O, Hirai M, Satoh M, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Oct;42(10):1851-7.
This is the first report of cerebral blood flow measurement with transcranial Doppler (TCD) during aortic arch reconstruction using continuous retrograde cerebral perfusion (CRCP) with deep hypothermia. Cerebral blood flow velocity was measured in 6 patients. CRCP was performed via the superior vena cava (SVC) at 30 cmH2O of internal juglar vein pressure and at 18 degrees C or lower of minimum bladder temperature. During the operation, the flow velocity of the middle cerebral artery (MCA) was continuously measured with TCD fixed on the temple. The cerebral blood flow during CRCP was different in each of the 6 patient. The retrograde MCA flow could be measured during CRCP in 3 patients, and the flow velocity was 11-60% of the MCA flow velocity before cardiopulmonary bypass. In the other 3 patients, retrograde MCA flow could not be detected during CRCP, but antegrade MCA flow could be found after antegrade perfusion was resumed. The antegrade flow velocity right after CRCP became more than the MCA flow before CRCP, which was regarded as a reaction due to cerebral ischemia. All the patients awoke within several (2-9) hours after operations and had no permanent neurological complications. But 2 patients developed drowsiness for several days after the operations; their CRCP times were 127 and 131 minutes. It is concluded that CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is a simple technique for brain protection, but the cerebral blood flow during CRCP is different in each patient.(ABSTRACT TRUNCATED AT 250 WORDS)
这是首例关于在主动脉弓重建术中使用深低温持续逆行脑灌注（CRCP）时，经颅多普勒（TCD）测量脑血流的报告。对6例患者进行了脑血流速度测量。CRCP通过上腔静脉（SVC）进行，颈内静脉压力为30 cmH₂O，最低膀胱温度为18℃或更低。手术过程中，将TCD固定在颞部，持续测量大脑中动脉（MCA）的血流速度。6例患者在CRCP期间的脑血流各不相同。3例患者在CRCP期间可测量到MCA的逆行血流，其流速为体外循环前MCA流速的11% - 60%。另外3例患者在CRCP期间未检测到MCA的逆行血流，但在恢复顺行灌注后可发现顺行血流。CRCP后即刻的顺行血流速度超过了CRCP前的MCA血流速度，这被认为是脑缺血的一种反应。所有患者术后数小时（2 - 9小时）内苏醒，且无永久性神经并发症。但有2例患者术后出现了数天的嗜睡；他们的CRCP时间分别为127分钟和131分钟。结论是，CRCP是一种简单的脑保护技术，但CRCP期间的脑血流在每个患者中有所不同。（摘要截短至250字）
