Bavaria J E, Pochettino A
Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104-4227, USA.
Semin Thorac Cardiovasc Surg. 1997 Jul;9(3):222-32.
Retrograde cerebral perfusion (RCP) was first introduced to treat air embolism during cardiopulmonary bypass (CPB). Its use was reintroduced to extend the safety of hypothermic circulatory arrest (HCA) during operations involving an open aortic arch. RCP seems to prevent cerebral rewarming during HCA. Both clinical and animal data suggest that RCP provides between 10% and 30% of baseline cerebral blood flow when administered through the superior vena cava (SVC) at jugular pressures of 20 to 25 mm Hg. RCP flows producing jugular venous pressures higher than 30 mm Hg may cause cerebral edema. Cerebral blood flow generated by RCP is able to sustain some cerebral metabolic activity, yet is not able to fully meet cerebral energy demands even at temperatures of 12 degrees to 18 degrees C. RCP may further prevent embolic events during aortic arch surgery when administered at moderate jugular vein pressures (< 40 mm Hg). Clinical results suggest that RCP, when applied during aortic arch reconstruction, may extend the safe HCA period and improve morbidity and mortality, especially when HCA times are more than 60 minutes. RCP applied in patients and severe carotid and brachiocephalic occlusive disease may be ineffective, and caution is in order when RCP times are greater than 90 minutes.
逆行性脑灌注（RCP）最初被用于治疗体外循环（CPB）期间的空气栓塞。在涉及开放主动脉弓的手术中，其应用被重新引入以延长低温循环停搏（HCA）的安全性。RCP似乎可防止HCA期间脑复温。临床和动物数据均表明，当通过上腔静脉（SVC）以20至25 mmHg的颈静脉压力进行RCP时，其可提供10%至30%的基线脑血流量。产生高于30 mmHg颈静脉压力的RCP流量可能会导致脑水肿。RCP产生的脑血流量能够维持一定的脑代谢活动，但即使在12摄氏度至18摄氏度的温度下也无法完全满足脑能量需求。在主动脉弓手术期间，以适度的颈静脉压力（<40 mmHg）进行RCP可能会进一步预防栓塞事件。临床结果表明，在主动脉弓重建期间应用RCP可能会延长安全的HCA时间，并改善发病率和死亡率，尤其是当HCA时间超过60分钟时。在患有严重颈动脉和头臂闭塞性疾病的患者中应用RCP可能无效，并且当RCP时间超过90分钟时需谨慎使用。
