OPTIMAL PERFUSION-PRESSURE FOR EXPERIMENTAL RETROGRADE CEREBRAL PERFUSION

被引:47
作者
NOJIMA, T
MAGARA, T
NAKAJIMA, Y
WATERIDA, S
ONOE, M
SUGITA, T
MORI, A
机构
[1] Department of Cardiovascular Surgery, Shiga Seuinbyo Medical Center, Shiga
[2] Second Department of Surgery, Shiga University of Medical Science, Otsu, Shiga
关键词
D O I
10.1111/j.1540-8191.1994.tb00888.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We evaluated cerebral metabolism during retrograde cerebral perfusion (RCP) and circulatory arrest during profound hypothermia, and also investigated the effects of perfusion pressure on RCP. Twenty-four adult mongrel dogs were placed on cardiopulmonary bypass and cooled to a nasopharyngeal temperature of 20-degrees-C. At this temperature, hypothermic circulatory arrest (HCA; n = 6), and RCP with a perfusion pressure of 10 mmHg (RCP10; n = 6), 20 mmHg (RCP20; n = 6), and 30 mmHg (RCP30; n = 6) were carried out for 60 minutes. RCP was performed with oxygenated blood via the bilateral maxillary veins, and the retrograde flow rate was regulated to maintain a mean perfusion pressure of 10, 20, or 30 mmHg in the external jugular vein. At 60 minutes of RCP, we measured nasopharyngeal temperature; regional cerebral blood flow (rCBF); cerebral oxygen consumption, carbon dioxide excretion, and excess lactate; cerebral tissue adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP) and energy charge; and cerebral tissue water content. In the RCP10 group, there was excess cerebral lactate, and ATP and energy charge were low. In the RCP30 group, the water content of cerebral tissue was significantly higher than in other groups. In the RCP20 group, temperature was maintained in a narrow range, oxygen consumption and carbon dioxide excretion could be observed, there was no excess lactate, and ATP and energy charge were significantly higher than in the HCA group. In conclusion, RCP can provide adequate metabolic support for the brain during circulatory arrest, and a perfusion pressure of 20 mmHg is most appropriate for RCP.
引用
收藏
页码:548 / 559
页数:12
相关论文
共 58 条
[1]  
Ueda Y, Miki S., Kusuhara K, Et al., Surgical treatment of the aneurysm or dissection involving the ascending aorta and aortic arch utilizing circulatory arrest and retrograde perfusion, J Jpn Assn Thorac Surg, 36, pp. 161-166, (1988)
[2]  
Kusuhara K, Miki S, Ueda Y, Et al., Operative technique for aortic aneurysm using profound hypothermic cerebral circulatory arrest with intermittent retrograde cerebral perfusion through the superior vena cava, Jpn J Thorac Surg, 41, pp. 1050-1054, (1988)
[3]  
Ueda Y, Miki S, Kusuhara K, Et al., Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion, J Cardiovasc Surg, 31, pp. 553-558, (1990)
[4]  
Murase M, Maeda M, Tomida Y, Et al., Continuous retrograde cerebral perfusion for brain protection during hypothermic circulatory arrest at operation of dissecting aneurysm, Jpn J Artif Organs, 20, pp. 1244-1248, (1991)
[5]  
Ueda Y, Miki S, Kusuhara K, Et al., Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm, Eur J Cardiothorac Surg, 6, pp. 36-41, (1992)
[6]  
Ueda Y, Miki S., Okita Y, Et al., The protective effect of continuous retrograde cerebral perfusion on the central nervous system during deep hypothermic systemic circulatory arrest, J Jpn Assn Thorac Surg, 41, pp. 559-568, (1993)
[7]  
Safi HJ, Brien HW, Winter JN., Et al., Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair, Ann Thorac Surg, 56, pp. 270-276, (1993)
[8]  
Yamashita C, Nakamura H, Nishikawa Y, Et al., Retrograde cerebral perfusion with circulatory arrest in aortic aneurysms, Ann Thorac Surg, 54, pp. 566-568, (1992)
[9]  
Yamashita C, Okada M, Retrograde cerebral perfusion with circulatory arrest for aortic arch aneurysm, Jpn J Thorac Surg, 46, pp. 672-676, (1993)
[10]  
Imamaki M, Hashimoto A, Hirayama T, Et al., A clinical assessment of efficacy in continuous retrograde cerebral perfusion method, Jpn J Thorac Surg, 45, pp. 755-761, (1992)