Adequate cerebral perfusion pressure during rewarming to prevent ischemic deterioration after therapeutic hypothermia

被引:7
作者
Aoki, A
Mori, K
Maeda, M
机构
[1] Juntendo Univ, Izunagaoka Hosp, Dept Neurosurg, Shizuoka 4102295, Japan
[2] Juntendo Casualty Ctr, Shizuoka, Japan
关键词
hypothermia; cerebral perfusion pressure; rewarming; cerebral ischemia; misery perfusion; glutamate;
D O I
10.1179/016164102101199909
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Ischemic deterioration during rewarming is one of the most notable clinical complications after successful therapeutic cerebral hypothermia, but the mechanism is not completely understood. Hypothermia may cause vasoconstriction and relative ischemia, especially with insufficient cerebral perfusion pressure (CPP). Various parameters were evaluated to determine the critical CPP threshold to avoid ischemia during rewarming. Cat experimental head injury was induced by inflating an epidural rubber balloon, and intracranial pressure was maintained at 30 mmHg. During rewarming after cerebral hypothermia, CPP was maintained at greater than or equal to120 mmHg (n = 16), 90 mmHg (n = 11), 60 mmHg (n = 11), and 40 mmHg (n = 4) by controlling the blood pressure. Cerebral blood flow, cerebral metabolic rate for oxygen, arteriovenous difference of oxygen (AVDO(2)), cerebral venous oxygen saturation (ScvO(2)), and extracellular glutamate concentrations were monitored by glutamate oxidase electrode. After rewarming, the cerebral metabolic parameters were almost restored to the pre-injury level in animals with CPP of more than 90 mmHg. However, in the animals with CPP = 60 mmHg, all parameters significantly deteriorated and indicated misery perfusion; ScvO(2) was low (29.5 +/- 1.1%), AVDO(2) was significantly high (9.9 +/- 0.8 ml 100 g(-1) min(-1)) (one-way analysis of variance, p < 0.05), and electron microscopic features showed subcellular ischemic change. Extracellular glutamate significantly increased during the rewarming period only in the CPP = 40 mmHg group. CPP less than 60 mmHg during rewarming causes secondary ischemic insult, which might indicate continuation of cerebral vasoconstriction in hypothermia. CPP higher than 90 mmHg is required to avoid the potential risk of relative ischemia after hypothermia.
引用
收藏
页码:271 / 280
页数:10
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