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目的探索幼猪在深低温体外循环中的最适区域性脑灌注(RCP)流量,为先天性心脏病(先心病)小儿患者术中脑保护策略提供理论基础。方法 20只健康幼猪,年龄23.7±2.1d,体重6.4±0.6kg,采用随机数字表法分为4组,每组各5例。对照组为单纯深低温停循环(DHCA组);实验组按不同RCP流量分为3组:RCP25组,流量为25.9±3.0ml(kg.min);RCP50组,流量为49.7±1.8ml/(kg.min);RCP80组,流量为79.5±0.9ml/(kg.min);通过检测血浆中建立CPB前(T1)、DHCA或RCP前(T2)、RCP结束后10min(T3)、停机前(T4)、CPB结束后1h(T5)以及2h(T6)6个时间点检测血浆中的S-100β蛋白、神经元特异性烯醇化酶(NSE)的浓度、脑氧摄取率(CEO2)及大脑皮质半胱天冬氨酸酶3(caspase 3)的含量,评估不同RCP流量的脑保护效果。结果各组幼猪血浆中S-100β蛋白和NSE的浓度于T4时明显升高,并于T5时达到高峰(P<0.05);RCP50组血浆中S-100β蛋白和NSE的浓度从T4时开始明显低于DHCA组和RCP80组(P<0.05),与RCP25组相比,其差异无统计学意义(P>0.05)。各组CEO2在T1时差异无统计学意义(P>0.05),在T2时明显降低(P<0.05)。DHCA组、RCP25组和RCP50组的CEO2在T3时开始升高,RCP80组在T3时稍微下降,但其差异无统计学意义(P>0.05);从T4开始,RCP25组和RCP50组的CEO2与DHCA组和RCP80组更接近于基础值(T1)(P<0.05)。大脑皮质中caspase3的含量在3种不同流量的RCP组明显低于DHCA组(F=23.54,P<0.01),其中RCP25组及RCP50组明显低于RCP80组(F=23.54,P<0.01),而RCP25组与RCP50组的caspase 3含量差异无统计学意义(P>0.05)。结论在我们建立的幼猪深低温体外循环模型中,RCP最适灌注流量为25～50ml/(kg.min),并且趋向于50ml/(kg.min)。
Objective To explore the optimal regional cerebral perfusion (RCP) flow rate in cryogenic cardiopulmonary bypass in young pigs and to provide a theoretical basis for intraoperative cerebral protection strategies in children with congenital heart disease (CHD). Methods Twenty healthy pigs, aged 23.7 ± 2.1 days and weighing 6.4 ± 0.6 kg, were divided into 4 groups with 5 cases in each group. The control group was simple hypothermic circulatory arrest (DHCA group). The experimental group was divided into three groups according to different RCP flow rate: RCP25 group, the flow rate was 25.9 ± 3.0ml (kg.min); RCP50 group, the flow rate was 49.7 ± 1.8ml / ( (T), DHCA or pre-RCP (T2), 10 min after RCP (T3), before the shutdown The levels of S-100βprotein, neuron-specific enolase (NSE), brain oxygen uptake (CEO2), and the ratio of brain oxygen uptake (PO2) were measured at different time points (T4), 1h (T5) and 2h (T6) Cerebral cortex caspase 3 levels were evaluated for brain protection with different RCP fluxes. Results The plasma concentrations of S-100β protein and NSE in each group were significantly increased at T4 and peaked at T5 (P <0.05). The concentrations of S-100β protein and NSE in plasma of RCP50 group increased from T4 Which was significantly lower than that in DHCA group and RCP80 group (P <0.05). Compared with RCP25 group, the difference was not statistically significant (P> 0.05). There was no significant difference of CEO2 between T1 and T2 groups (P> 0.05). CEO2 in DHCA group, RCP25 group and RCP50 group began to increase at T3, while RCP80 group decreased slightly at T3, but the difference was not statistically significant (P> 0.05). From T4, CEO2 and RCP50 group The DHCA and RCP80 groups were closer to the baseline (T1) (P <0.05). The content of caspase3 in cerebral cortex was significantly lower in RCP group than in DHCA group (F = 23.54, P <0.01) at three different flow rates, and the levels in RCP25 group and RCP50 group were significantly lower than those in RCP80 group (F = 23.54, P <0.01) There was no significant difference in caspase 3 between RCP25 group and RCP50 group (P> 0.05). Conclusion In our established model of hypothermic cardiopulmonary bypass in young pigs, the optimum perfusion rate of RCP is 25 ~ 50ml / (kg · min) and tends to 50ml / (kg · min).