深低温停循环逆行性灌注脑保护

Cerebral Protection During Deep Hypothermic Circulatory Arrest by Retrograde Cerebral Perfusion

为评价上腔静脉逆行性灌注对脑保护的效果 ,对 10余年来的研究成果进行综述。上腔静脉逆行性灌注是深低温停循环脑保护的辅助手段 ,已证明在低温状态下 ,它为脑部提供低流量血流 ,维持脑部低温状态 ;提供部分氧和营养物质 ,运走代谢产物 ;减少气栓及栓塞的发生 ,从而延长了深低温停循环脑保护的安全时限 ,而脑水肿的危险性限制了该方法在临床的应用。在脑保护液中加入脑保护药物已取得一定进展 ,而上腔静脉逆行性灌注中束闭下腔静脉的研究仍在进行中。在应用该方法时 ,应注意掌握其适应证及预防可能发生的危险。

To valuate cerebral protection by retrograde cerebral perfusion (RCP) via superior vena cava,the study results for the last ten years have been reviewed.RCP is regarded as an assistant method in deep hypothermic circulatory arrest(DHCA) in that it provides partial brain blood flow,maintains a low brain temperature,optimizes cerebral metabolic function during DHCA by supplying oxygen and some nutrient and removal of catabolic products;it also reduces the incidence of cerebral embolization by flushing out air and particulate microemboli from the arterial tree before the reinstitution of antegrade perfusion,thus prolonging the limitation of safety of DHCA.But brain edema probably happens to restrict the clinical use of this method.Some protecting drugs including cerebral protective fluid is in research and some progresses have been achieved,while inferior vena cava occlusion during RCP is still in research.Indications for RCP should be strictly identified and possibl risk should be prevented.