HYPERPERFUSION AND CEREBRAL-DYSFUNCTION - EFFECT OF DIFFERING ACID-BASE MANAGEMENT DURING CARDIOPULMONARY BYPASS

被引：35

作者：

PATEL, RL ^{[1
]}

TURTLE, MRJ ^{[1
]}

CHAMBERS, DJ ^{[1
]}

NEWMAN, S ^{[1
]}

VENN, GE ^{[1
]}

BORST, HG ^{[1
]}

TREASURE, T ^{[1
]}

FONTAN, F ^{[1
]}

机构：

[1] ST THOMAS HOSP,DEPT CARDIOTHORAC SURG,LAMBETH PALACE RD,LONDON SE1 7EH,ENGLAND

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1993年 / 7卷 / 09期

关键词：

ACID-BASE MANAGEMENT; CARDIOPULMONARY BYPASS; CEREBRAL BLOOD FLOW; NEUROPSYCHOLOGICAL FUNCTION; CEREBRAL METABOLISM;

D O I：

10.1016/1010-7940(93)90274-F

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Alterations in cerebral blood flow (CBF) occurring during cardiopulmonary bypass (CPB), which are thought to be responsible for increased morbidity, are probably related to changes in arterial carbon dioxide during acid-base management. In this study, 70 patients undergoing elective coronary artery bypass surgery (CABS) were randomised to one of two differing, but widely practised, cardiopulmonary bypass acid-base protocols; pH-stat and alpha-stat. Cerebral blood flow was measured during surgery using the xenon- 1 33 isotope clearance technique. Cerebral oxygen metabolism was measured as the cerebral metabolic rate for oxygen (CMRO2) and matching of the cerebral blood flow to oxygen demand as the cerebral extraction ratio for oxygen (CERO2). Detailed neuropsychological tests were conducted in all patients before surgery and repeated at 6 weeks after surgery for assessment of changes in cognitive function. During hypothermic (28-degrees-C) CPB, CBF was significantly greater (P < 0.001) in the pH-stat group (41 ml/100 g per min; 95% confidence intervals (CI), 39-43) than in the alpha-stat group (24 ml/100 g per min; 95% CI, 22-26). The cerebral extraction ratio for oxygen indicated a degree of mismatch of cerebral perfusion and demand during CPB in both pH-stat and alpha-stat groups (0.12; 95% Cl, 0.11-0.14 and 0.25; 95% Cl, 0.22-0.28, respectively). This mismatch was far more pronounced in the pH-stat group than in the alpha-stat group, indicating greater disruption in cerebral autoregulation in the former group. Neuropsychological assessment revealed a significantly higher proportion of patients (Fisher exact P = 0.02) faring less well at 6 weeks in the pH-stat group than in the alpha-stat group (17/35 (48.6%); 95% CI, 32.0 - 65.1% and 7/35 (20%); 95% CI, 6.7-33.2%, respectively). Alpha-stat managed patients had less disruption of cerebral autoregulation during CPB accompanied by a reduced incidence of post-operative cerebral dysfunction.

引用

页码：457 / 464

页数：8

共 32 条

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