摘要
目的：探讨利于停循环术中脑保护的血气管理策略。方法：１８ 头猪建立体外循环，按降温期血气管理策略随机分组：即α稳态组（α组） ，ｐＨ稳态组（Ｐ组） ；两种稳态方法联合应用组Ｐ→α组。于常温转流１０ 分钟、降温末、复灌５ 分钟、复温末共４ 个时点测定脑血流量（ＣＢＦ） 、脑氧代谢率（ＣＭＲＯ２） 、脑组织ＡＴＰ含量；降温期和停循环末测鼻咽温度和脑皮层温度和深部温度；脑电图观察；复温末行脑超微结构观察。结果：降温期Ｐ组和Ｐ→α组脑降温均匀有效；降温末Ｐ 组ＣＢＦ较另两组减少小，ＣＭＲＯ２ 以Ｐ组最低，α组最高，差异显著；复温末ＡＴＰ恢复以α组最慢，脑电活动Ｐ 组恢复最快，α组最慢；超微结构示α组神经细胞肿胀明显重于另两组。结论：深低温停循环时，应用ｐＨ稳态或ｐＨ→α稳态较用α稳态血气管理方法有更好的脑保护作用。
Aim:To assess an optimal method on cerebral protection during deep hypothemia circulatory arrest.Methods:Eighteen piglets were divided randomly into three groups:the group α (α-stat group),the group P(pH-stat group),the group P→α(combining the two stat).The piglets were perfused according to clinical methods.Measurement of cerebral blood flow(CBF),cerebral metabolism rate for oxygen(CMRO 2),the content of ATP were made at four different time intervals(the end of ten minutes' normothermic perfusion,the end of cooling,5 minutes of reperfusion and after rewarming).The nasopharyngeal temperature,brain cortical temperature and basilar brain temperature were monitored continously during cooling and at the end of circulatory arrest.EEG were monitored continously.The brain tissues were taken for ultrastructural test after rewarming.Results:The temperature in both the group P and group P→α were reduced significantly.By the end of cooling period,CBF were decreased in all groups,however,in group P CBF decreased much less than other two groups.The recovery of ATP in group P and group P→α were faster than that of the group α after rewarming .The mean latency to recovery of EEG activity after the onset of reperfusion was the shortest in the group P and the longest in the group α.Ultrastructural test discovered that mitachondial edema were severer in the group α.Conclusion:Using pH-stat or pH→α -stat blood gas managemen one can get better cerebral protection than using α-stat strategy during deep hypothemia circulatory arrest .
出处
《中华胸心血管外科杂志》
CSCD
北大核心
1999年第6期367-370,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
卫生部基金!(编号:96-2- 288)
关键词
深低温停循环
血气管理
脑保护
实验
Deep hypothemic and circulatory arrest Blood gas management Cerebral protection
