CAJ | 학술논문

目的观察猪主动脉手术不同阶段脑血流流量、血流分布,以及氧代谢变化状况.方法 18～22 kg雌性小型猪8只,通过右房静脉引流,右侧颈动脉和升主动脉插入动脉灌注管建立单泵双管灌注模型,降温至20℃时停止升主动脉灌注,实施右侧选择性脑灌注,60 min后恢复循环,静脉氧饱和度达到95％以上时开始复温,膀胱温度达到36C停止体外循环转流.整个过程中使用TRANSONIC超声血流仪监测动脉插管内灌注流量,记录灌注压力,使用近红外分光光度仪监测脑氧饱和度( rSO2)动态变化,不同时间点监测血气分析和生化检查.结果观察期间右侧股动脉压力维持(60±20) mmHg.总的血液灌注流量(85.30±6.81) ml·kg-1·min-1,其中右侧脑灌注流量( 14.42±1.76) ml·kg-1·min-1,占全部灌注流量(16.72±2.77)％.停循环选择性脑灌注期间,脑灌注流量(15.11±0.44) ml·kg-1 · min-1.实验不同阶段静脉氧饱和度波动于0.40 ～0.99(0.83 ±0.13),rSO2 0.56～0.79(0.67±0.06).停循环后血糖[(8.18±3.34) mmol/L]和乳酸浓度[(9.30±2.31) mmol/L]较停循环前明显升高(P＜0.05).结论可以连续性观测主动脉手术体外循环转流以及停循环期间的全身以及脑部血流分布、氧代谢的小型猪动物模型,是进行主动脉弓部心血管外科研究的良好模型.
목적 관찰저주동맥수술불동계단뇌혈류류량、혈류분포,이급양대사변화상황.방법 18～22 kg자성소형저8지,통과우방정맥인류,우측경동맥화승주동맥삽입동맥관주관건립단빙쌍관관주모형,강온지20℃시정지승주동맥관주,실시우측선택성뇌관주,60 min후회복순배,정맥양포화도체도95％이상시개시복온,방광온도체도36C정지체외순배전류.정개과정중사용TRANSONIC초성혈류의감측동맥삽관내관주류량,기록관주압력,사용근홍외분광광도의감측뇌양포화도( rSO2)동태변화,불동시간점감측혈기분석화생화검사.결과 관찰기간우측고동맥압력유지(60±20) mmHg.총적혈액관주류량(85.30±6.81) ml·kg-1·min-1,기중우측뇌관주류량( 14.42±1.76) ml·kg-1·min-1,점전부관주류량(16.72±2.77)％.정순배선택성뇌관주기간,뇌관주류량(15.11±0.44) ml·kg-1 · min-1.실험불동계단정맥양포화도파동우0.40 ～0.99(0.83 ±0.13),rSO2 0.56～0.79(0.67±0.06).정순배후혈당[(8.18±3.34) mmol/L]화유산농도[(9.30±2.31) mmol/L]교정순배전명현승고(P＜0.05).결론 가이련속성관측주동맥수술체외순배전류이급정순배기간적전신이급뇌부혈류분포、양대사적소형저동물모형,시진행주동맥궁부심혈관외과연구적량호모형.
Objective A single pump and double arterial lines piglet model was established in this piglet's experiment.The preliminary study of cerebral blood flow proportion and distribution was performed continuously during the procedure.Methods Eight female piglets were utilized in this study.The body weight ranged from 18 kg to 22 kg.The right atrium was carmulated for venous drainage.Double arterial lines were established through cannulating into right carotid artery and ascending aortic aorta.Selective antegrade cerebral perfusion (SACP) through right carotid artery started after bladder temperature was decreased to 20℃ and the perfusion from ascending aortic aorta was interrupted.The perfusion through ascending aortic aorta resumed following 60 minutes of circulatory arrest.Traditional rewarming strategy was adopted and the experiment ended when bladder temperature attained 36℃.The real-time blood flow in the double arterial lines was monitored using a TS410 transit-time tubing flowmeter (Transonic Systems Inc.,Ithaca,NY).Blood pressure in femoral artery,intra-circuit pressure was recorded every five minutes interval.Regional cerebral oxygen saturation ( rSO2 ) was assessed with NIRO-200 oximeter using Near-infrared spectroscopy (Hamamatsu Photonics,Hamamatsu City,Japan ) and mixed venous oxygen saturation ( SvO2 ).Blood samples were drawn for blood chemistry measurement prior to extracorporeal circulation,before circulatory arrest and at the end of experiment.Results Arterial blood pressure was maintained at (60 ± 20) mm Hg.Total blood flow perfusion was(85.30 ±6.81)ml · kg-1 · min-1 and(14.42 ±1.76) ml · kg-1 · min-1 in right carotid artery.The proportion of cerebral blood flow was (16.72 ± 2.77 )％ of total perfusion.Cerebral blood perfusion was controlled with( 15.11 ± 0.44)ml · kg - 1 · min - 1 during SACP.Compared to SvO2,rSO2 remained stable during the procedure.The plasma concentration of