Nojima T, Mori A, Watarida S, Onoe M, Sugita T, Shiraishi S, Nakajima Y, Mastuno S, Tabata R
Second Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Kyobu Geka. 1993 Jul;46(8 Suppl):690-4.
Retrograde cerebral perfusion (RCP) is used to prolong the safe period of circulatory arrest under profound hypothermia. However, this technique now varies in some maneuvers at different institutions. This study investigated the effects on cerebral metabolism of clamping blood flow through the IVC cannula during RCP using fourteen adult mongrel dogs. During circulatory arrest, RCP by way of the bilateral internal maxillary vein was performed. In seven dogs, blood flow was drained through IVC cannula (IVC-drained group) and in the other seven dogs, the blood flow was clamped during RCP (IVC-clamped group). During RCP, the percent of returned blood volume, oxygen consumption, exudation of carbon-dioxide, and oxygen saturation of the returned blood were significantly higher in the IVC-clamped group than in the IVC-drained group, and the concentration of serum CK-BB in the IVC-clamp group was significantly lower than in the IVC-drained group. However, there was no statistical difference between the two groups concerning the regional cerebral blood flow or water content of the cerebral tissue. Concerning about these results, a part of perfused blood passed through not only the extra cranial veno-venous connection but also the intra cranial veno-capillary-venous connection. We concluded that clamping of the venous blood flow through the IVC cannula during RCP is a more protective procedure for cerebral tissue.
逆行脑灌注(RCP)用于延长深度低温下循环停止的安全期。然而,目前该技术在不同机构的一些操作上存在差异。本研究使用14只成年杂种犬,调查了在RCP期间夹闭通过下腔静脉插管的血流对脑代谢的影响。在循环停止期间,通过双侧上颌内静脉进行RCP。7只犬中,血流通过下腔静脉插管引流(下腔静脉引流组),另外7只犬在RCP期间夹闭血流(下腔静脉夹闭组)。在RCP期间,下腔静脉夹闭组的回流血量百分比、氧消耗、二氧化碳排出量和回流血氧饱和度显著高于下腔静脉引流组,且下腔静脉夹闭组血清CK - BB浓度显著低于下腔静脉引流组。然而,两组在局部脑血流量或脑组织含水量方面无统计学差异。基于这些结果,一部分灌注血液不仅通过颅外静脉 - 静脉连接,还通过颅内静脉 - 毛细血管 - 静脉连接。我们得出结论,RCP期间夹闭通过下腔静脉插管的静脉血流对脑组织是一种更具保护作用的操作。