Yoshitaka H, Takamoto S, Okita Y, Ando M, Morota T, Yamaki H
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jun;45(6):806-11.
The safety limit of retrograde cerebral perfusion (RCP) in aortic arch reconstruction was evaluated in comparison with long (> or = 60 min: group A = 28 cases) and short (< 60 min: group B = 88 cases) RCP time (RCPT). RCPT was 60-94 min in group A and 24-59 min in group B. Hospital mortality was 7.1% and 6.8% in group A and B, respectively. There was no case who was died due to cerebral insufficiency. Postoperative neurological complication was observed 3 in group A and 3 in group B. There was no significance between 2 groups. There were no significant differences in the time to awake, ICU stay, electroencephalogram, and cognitive functions between 2 groups. Based on these results, the safety limit of RCP is over than 60 min and, maybe, about 90 min. We monitored the increase of deoxygenated hemoglobin (HbR) during RCP using a near infrared spectroscopy (n = 55). Since HbR increased gradually during RCP, HbR reflects oxygen metabolism non-invasively in the brain. HbR can be one of useful indexes of the brain protection during RCP.
通过比较长时间（≥60分钟：A组=28例）和短时间（<60分钟：B组=88例）的逆行脑灌注（RCP）时间，评估了主动脉弓重建中RCP的安全限度。A组的RCP时间为60-94分钟，B组为24-59分钟。A组和B组的医院死亡率分别为7.1%和6.8%。没有病例因脑供血不足死亡。A组和B组术后均观察到3例神经并发症。两组之间无显著差异。两组在清醒时间、重症监护病房停留时间、脑电图和认知功能方面无显著差异。基于这些结果，RCP的安全限度超过60分钟，可能约为90分钟。我们使用近红外光谱法监测了RCP期间脱氧血红蛋白（HbR）的增加（n=55）。由于RCP期间HbR逐渐增加，HbR可无创反映大脑中的氧代谢。HbR可以成为RCP期间脑保护的有用指标之一。
