CEREBRAL BLOOD-FLOW VELOCITY IN PEDIATRIC-PATIENTS IS REDUCED AFTER CARDIOPULMONARY BYPASS WITH PROFOUND HYPOTHERMIA

被引:31
作者
JONASSEN, AE
QUAEGEBEUR, JM
YOUNG, WL
机构
[1] COLUMBIA UNIV COLL PHYS & SURG,DEPT SURG,NEW YORK,NY 10032
[2] COLUMBIA UNIV COLL PHYS & SURG,DEPT NEUROL SURG,NEW YORK,NY 10032
[3] COLUMBIA UNIV COLL PHYS & SURG,DEPT RADIOL,NEW YORK,NY 10032
关键词
D O I
10.1016/S0022-5223(05)80160-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Transcranial Doppler sonography of the middle cerebral artery was used to determine whether cerebral perfusion was detectable in low how states during operations with cardiopulmonary bypass in pediatric patients. Quantitative and qualitative differences in cerebral blood flow velocity after rewarming in patients treated with continuous low-flow bypass or deep hypothermic circulatory arrest were assessed, To determine whether the alterations in cerebrovascular resistance pattern observed in our patients undergoing profound hypothermia was more a function of perfusion technique than of minimum temperature during operation, a third group of patients treated with moderate hypothermia,vas studied, The three patient groups were the arrest group (N = 16), comprised of patients undergoing circulatory arrest at 18 degrees to 20 degrees C; the low-flow group (N = 16), patients treated with continuous low-flow (cardiac index 0.5 L/min per square meter) bypass at 18 degrees to 20 degrees C; and the moderate group (N = 5), patients treated with moderate hypothermia at 24 degrees to 28 degrees C. Flow velocity was detectable in ail patients in the low-flow group, with mean arterial pressures as low as 15 mm Hg. Mean flow velocity was reduced after bypass as compared with prebypass values in both the arrest and low-dow groups (p = 0.0001). Mean flow velocity increased after bypass in the moderate group (p = 0.0001). A Doppler waveform pattern consistent with high cerebrovascular resistance was found in 67% of patients in the arrest group and 44% of those in the low-flow group, None of the patients in the moderate group exhibited such a pattern, Patients treated with profound hypothermia who underwent a period of cold full-flow reperfusion before rewarming did not exhibit this high resistance pattern after rewarming, The present findings indicate that profound hypothermia may evoke changes in the cerebral vasculature that result in decreased mean cerebral blood flow velocity after cardiopulmonary bypass rewarming. A period of cold full-flow reperfusion before rewarming may prevent these alterations and improve cerebral perfusion during rewarming.
引用
收藏
页码:934 / 943
页数:10
相关论文
共 27 条
[1]   ABSENT DIASTOLIC CEREBRAL BLOOD-FLOW VELOCITY AFTER CIRCULATORY ARREST BUT NOT AFTER LOW-FLOW IN INFANTS [J].
ASTUDILLO, R ;
VANDERLINDEN, J ;
EKROTH, R ;
WESSLEN, O ;
HALLHAGEN, S ;
SCALLAN, M ;
SHORE, D ;
LINCOLN, C .
ANNALS OF THORACIC SURGERY, 1993, 56 (03) :515-519
[2]  
BELLINGER DC, 1991, PEDIATRICS, V87, P701
[3]   TRANSCRANIAL DOPPLER MEASUREMENT OF MIDDLE CEREBRAL-ARTERY BLOOD-FLOW VELOCITY - A VALIDATION-STUDY [J].
BISHOP, CCR ;
POWELL, S ;
RUTT, D ;
BROWSE, NL .
STROKE, 1986, 17 (05) :913-915
[4]   AGE DEPENDENCE OF FLOW VELOCITIES IN BASAL CEREBRAL-ARTERIES [J].
BODE, H ;
WAIS, U .
ARCHIVES OF DISEASE IN CHILDHOOD, 1988, 63 (06) :606-611
[5]   TRANSCRANIAL DOPPLER MEASUREMENTS OF THE MIDDLE CEREBRAL-ARTERY - EFFECT OF HEMATOCRIT [J].
BRASS, LM ;
PAVLAKIS, SG ;
DEVIVO, D ;
PIOMELLI, S ;
MOHR, JP .
STROKE, 1988, 19 (12) :1466-1469
[6]   ANTERIOR FONTANEL PRESSURE AND VISUAL EVOKED-POTENTIALS IN NEONATES AND INFANTS UNDERGOING PROFOUND HYPOTHERMIC CIRCULATORY ARREST [J].
BURROWS, FA ;
HILLIER, SC ;
MCLEOD, ME ;
IRON, KS ;
TAYLOR, MJ .
ANESTHESIOLOGY, 1990, 73 (04) :632-636
[7]   NEUROLOGIC SEQUELAE OF OPEN-HEART SURGERY IN CHILDREN - AN IRRITATING QUESTION [J].
FERRY, PC .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1990, 144 (03) :369-373
[8]  
FOX LS, 1984, J THORAC CARDIOV SUR, V87, P658
[9]   HEMORHEOLOGICAL ASPECTS OF THE PATHOPHYSIOLOGY OF CEREBRAL-ISCHEMIA [J].
GAEHTGENS, P ;
MARX, P .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 1987, 7 (03) :259-265
[10]  
GREELEY WJ, 1989, J THORAC CARDIOV SUR, V97, P737