Mori A
Second Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Ann Thorac Surg. 1993 Dec;56(6):1497-8. doi: 10.1016/0003-4975(93)90739-5.
We investigated the effects of pulsatile flow for retrograde cerebral perfusion under profound hypothermia. Total cardiopulmonary bypass was carried out in adult mongrel dogs to induce hypothermia. One hour of total circulatory arrest was then performed at 20 degrees C in the control group of 6 dogs. In another group of 6 dogs, after cardiac arrest was obtained at 20 degrees C, retrograde cerebral perfusion with nonpulsatile flow was performed through both sides of the internal maxillary vein for 60 minutes; in a third group of 6 dogs, retrograde pulsatile perfusion was continued for 60 minutes. At the end of either retrograde perfusion or total circulatory arrest for 60 minutes, cerebrospinal fluid pressure and blood flow in the cerebral tissues were measured, and cerebral tissues were collected to measure water and adenosine triphosphate content. A significant difference was found for water content between the group undergoing retrograde perfusion with pulsatile flow as opposed to nonpulsatile flow. Cerebral tissues in the group perfused retrogradely with nonpulsatile flow contained more water than in the group perfused with pulsatile flow. Cerebrospinal fluid pressure was lower in the group perfused retrogradely with pulsatile flow when compared with nonpulsatile flow, but no significant difference could be found. As for cerebral flow and adenosine triphosphate content, no significant differences could be found between the groups perfused retrogradely with pulsatile or with non-pulsatile flow. Values were always higher, nonetheless, in the groups perfused with pulsatile flow. We conclude that retrograde cerebral perfusion with pulsatile flow, when used under conditions of profound hypothermia, possesses more cerebroprotective effects than does non-pulsatile perfusion or circulatory arrest.
我们研究了在深度低温下搏动血流用于逆行性脑灌注的效果。在成年杂种犬中进行全心肺转流以诱导低温。然后在6只犬的对照组中于20℃进行1小时的全循环停搏。在另一组6只犬中，在20℃实现心脏停搏后，通过双侧上颌内静脉进行非搏动血流的逆行性脑灌注60分钟；在第三组6只犬中，进行逆行性搏动灌注60分钟。在逆行灌注或全循环停搏60分钟结束时，测量脑脊液压力和脑组织中的血流，并收集脑组织以测量水和三磷酸腺苷含量。发现搏动血流逆行灌注组与非搏动血流逆行灌注组之间的水含量存在显著差异。非搏动血流逆行灌注组的脑组织比搏动血流灌注组含有更多的水。与非搏动血流相比，搏动血流逆行灌注组的脑脊液压力较低，但未发现显著差异。至于脑血流和三磷酸腺苷含量，搏动血流逆行灌注组与非搏动血流逆行灌注组之间未发现显著差异。然而，搏动血流灌注组的值始终较高。我们得出结论，在深度低温条件下使用时，搏动血流逆行性脑灌注比非搏动灌注或循环停搏具有更多的脑保护作用。
