Midulla P S, Gandsas A, Sadeghi A M, Mezrow C K, Yerlioglu M E, Wang W, Wolfe D, Ergin M A, Griepp R B
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029.
J Card Surg. 1994 Sep;9(5):560-74; discussion 575. doi: 10.1111/j.1540-8191.1994.tb00889.x.
Retrograde cerebral perfusion (RCP) is a new method of cerebral protection that has been touted as an improvement over hypothermic circulatory arrest (HCA). However, RCP has been used clinically for durations and at temperatures that are "safe" for HCA alone. This study was designed to compare RCP to HCA and antegrade cerebral perfusion (ACP) deliberately exceeding "safe" limits, in order to determine unequivocally whether RCP provides better cerebral protection than HCA. Four groups of six Yorkshire pigs (20 to 30 kg) were randomly assigned to undergo 90 minutes of RCP, ACP, HCA, or HCA with heads packed in ice (HCA-HP) at an esophageal temperature of 20 degrees C. Arterial, mixed venous and cerebral venous oxygen, glucose and lactate contents; quantitative EEG; were monitored at baseline (37 degrees C); at the end of cooling cardiopulmonary bypass (20 degrees C); during rewarming (30 degrees C); and at two and four hours post intervention. Animals were recovered and were evaluated daily using a quantitative behavioral score (0 to 9). Mean behavioral score was lower in the HCA group than in the other three groups at seven days (HCA 5.8 +/- 1.1; RCP 8.5 +/- 0.2; ACP 9.0 +/- 0.0; HCA-HP 8.5 +/- 0.2, p < 0.05). Recovery of QEEG was better in the ACP group than in all others, but the RCP group had faster EEG recovery than HCA alone, although not better than HCA-HP (HCA 15 +/- 4; RCP 27 +/- 3; ACP 78 +/- 5; HCA-HP 19 +/- 3, p < 0.001). However, histopathological evidence of ischemic injury was present in 5 of 6 HCA animals and also in 4 of 6 of the HCP-HP group, but only in 1 of 6 RCP animals and in none of the ACP group. This study demonstrates that ACP affords the best cerebral protection by all outcome measures, but RCP provides clear improvement compared to HCA.
逆行性脑灌注（RCP）是一种新的脑保护方法，被认为是对低温循环停搏（HCA）的改进。然而，RCP在临床上的使用时长和温度仅对HCA而言是“安全的”。本研究旨在将RCP与故意超过“安全”限度的HCA和顺行性脑灌注（ACP）进行比较，以明确RCP是否比HCA提供更好的脑保护。将四组每组六只约克夏猪（20至30千克）随机分配，使其在食管温度为20摄氏度的情况下分别接受90分钟的RCP、ACP、HCA或头部冰敷的HCA（HCA-HP）。在基线（37摄氏度）、体外循环降温结束时（20摄氏度）、复温期间（30摄氏度）以及干预后两小时和四小时监测动脉、混合静脉和脑静脉的氧、葡萄糖和乳酸含量；定量脑电图。动物恢复后，每天使用定量行为评分（0至9）进行评估。在第7天时，HCA组的平均行为评分低于其他三组（HCA 5.8±1.1；RCP 8.5±0.2；ACP 9.0±0.0；HCA-HP 8.5±0.2，p<0.05）。ACP组的定量脑电图恢复情况优于其他所有组，但RCP组的脑电图恢复速度比单独的HCA组快，尽管不如HCA-HP组（HCA 15±4；RCP 27±3；ACP 78±5；HCA-HP 19±3，p<0.001）。然而，6只HCA动物中有5只以及HCP-HP组6只中有4只出现了缺血性损伤的组织病理学证据，但RCP组6只中只有1只出现，而ACP组则没有。本研究表明，从所有结果指标来看，ACP提供了最佳的脑保护，但与HCA相比，RCP有明显改善。
