一氧化氮的产生会影响深低温停循环后的脑灌注和代谢。

Nitric oxide production affects cerebral perfusion and metabolism after deep hypothermic circulatory arrest.

作者信息

Tsui S S, Kirshbom P M, Davies M J, Jacobs M T, Greeley W J, Kern F H, Gaynor J W, Ungerleider R M

机构信息

Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.

出版信息

Ann Thorac Surg. 1996 Jun;61(6):1699-707. doi: 10.1016/0003-4975(96)00197-X.

DOI:10.1016/0003-4975(96)00197-X

PMID:8651770

Abstract

BACKGROUND

Use of deep hypothermic circulatory arrest (DHCA) in infant cardiac surgery is associated with reduced cerebral perfusion and metabolism during the recovery period. We investigated the impairment of nitric oxide production as a possible cause.

METHODS

A group of 1-week-old piglets underwent normothermic cardiopulmonary bypass (group A); three other groups (B, C, and D; n = 6 per group) underwent 60 minutes of DHCA at 18 degrees C and 60 minutes of rewarming. The animals were then treated as follows: Groups A and B received L-omega-nitro-arginine-methyl-ester (L-NAME, 50 mg.kg-1); group C, saline solution; and group D, L-arginine (600 mg.kg-1).

RESULTS

In group A, global cerebral blood flow decreased to 37.3% +/- 4.2% of baseline after L-NAME administration (p < 0.005). In group B, global cerebral blood flow decreased to 44.6% +/- 4.4% of baseline after DHCA and 28.9% +/- 3.4% after L-NAME administration (p < 0.001). Following L-arginine treatment after DHCA (group D), global cerebral blood flow increased from 43.8% +/- 3.0% of baseline to 61.6% +/- 9.1% (p < 0.05); cerebral oxygen metabolism increased from 1.93 +/- 0.16 mL.min-1.100 g-1 after DHCA to 2.42 +/- 0.25 mL.min-1.100 g-1 (p < 0.05).

CONCLUSIONS

Tonal production of nitric oxide is impaired in the brain after DHCA and is partly responsible for the circulatory and metabolic changes observed. Stimulation of nitric oxide production (L-arginine) significantly improved recovery of cerebral blood flow and cerebral oxygen metabolism after DHCA.

摘要

背景

在婴儿心脏手术中使用深低温停循环（DHCA）与恢复期脑灌注和代谢减少有关。我们研究了一氧化氮生成受损作为可能原因的情况。

方法

一组1周龄仔猪接受常温体外循环（A组）；其他三组（B、C和D组，每组n = 6）在18℃下进行60分钟的DHCA和60分钟的复温。然后对动物进行如下处理：A组和B组给予L-ω-硝基精氨酸甲酯（L-NAME，50 mg·kg-1）；C组给予生理盐水；D组给予L-精氨酸（600 mg·kg-1）。

结果

在A组中，给予L-NAME后全脑血流量降至基线的37.3%±4.2%（p < 0.005）。在B组中，DHCA后全脑血流量降至基线的44.6%±4.4%，给予L-NAME后降至28.9%±3.4%（p < 0.001）。DHCA后给予L-精氨酸治疗（D组），全脑血流量从基线的43.8%±3.0%增加至61.6%±9.1%（p < 0.05）；脑氧代谢从DHCA后的1.93±0.16 mL·min-1·100 g-1增加至2.42±0.25 mL·min-1·100 g-1（p < 0.05）。