Ueda Y, Miki S, Okita Y, Tahata T, Ogino H, Sakai T, Morioka K, Matsuyama K
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
J Card Surg. 1994 Sep;9(5):584-94; discussion 594-5. doi: 10.1111/j.1540-8191.1994.tb00891.x.
Deep hypothermic circulatory arrest has been widely used as an adjunct for surgery of the aortic arch to protect the brain and other vital organs. We introduced the use of continuous retrograde cerebral perfusion via the superior vena cava during deep hypothermic circulatory arrest in 1987 and have used it in 33 patients. Continuous retrograde cerebral perfusion times ranged from 10 to 89 minutes (mean 40.2 +/- 22.5), and minimal nasopharyngeal temperatures ranged from 14 to 25 degrees C (mean 17.4 +/- 2.0). Two patients with a ruptured aneurysm died during operation due to bleeding and two other patients, with continuous retrograde cerebral perfusion time of 24 and 35 minutes, died 1 month postoperatively due to preoperative liver cirrhosis and sepsis. Two patients suffered from stroke. The remaining 27 patients, including 6 with from 60 to 82 minutes of continuous retrograde cerebral perfusion, had no complications related to continuous retrograde perfusion. During continuous retrograde cerebral perfusion, 66 pairs of blood samples from the perfusate and from the drainage back to the arch vessels were obtained. Analysis of these samples revealed that partial pressure of oxygen, saturation of oxygen, and oxygen content significantly decreased (p < 0.001), and partial pressure of carbon dioxide (CO2) and CO2 content significantly increased (p < 0.001). The nasopharyngeal temperature gradually increased at the rate of 0.01 to 0.03 degree C/min, but was maintained below 20 degrees C. These results reflect the fact that the aerobic metabolism of the brain is maintained during continuous retrograde cerebral perfusion due to oxygen and substrate availability. This technique offers the potential of metabolic support to the brain during deep hypothermic circulatory arrest and prolongs the safe time limits of deep hypothermic circulatory arrest in surgery of the aortic arch.
深度低温循环停止已被广泛用作主动脉弓手术的辅助手段，以保护大脑和其他重要器官。1987年，我们在深度低温循环停止期间引入了经上腔静脉持续逆行脑灌注，并已将其应用于33例患者。持续逆行脑灌注时间为10至89分钟（平均40.2±22.5），最低鼻咽温度为14至25摄氏度（平均17.4±2.0）。两名动脉瘤破裂患者在手术中因出血死亡，另外两名持续逆行脑灌注时间分别为24分钟和35分钟的患者，术后1个月因术前肝硬化和败血症死亡。两名患者发生中风。其余27例患者，包括6例持续逆行脑灌注时间为60至82分钟的患者，没有出现与持续逆行灌注相关的并发症。在持续逆行脑灌注期间，从灌注液和回流至主动脉弓血管的引流液中获取了66对血样。对这些样本的分析显示，氧分压、氧饱和度和氧含量显著降低（p<0.001），二氧化碳分压（CO2）和CO2含量显著升高（p<0.001）。鼻咽温度以每分钟0.01至0.03摄氏度的速度逐渐升高，但维持在20摄氏度以下。这些结果反映出，由于氧气和底物的供应，在持续逆行脑灌注期间大脑的有氧代谢得以维持。该技术在深度低温循环停止期间为大脑提供了代谢支持的潜力，并延长了主动脉弓手术中深度低温循环停止的安全时间限制。
