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1、不同灌注方法对深低温停循环下脑保护的实验研究作者：宋兵，任旭东，张巧燕，李元敏，程殿威，祁泉，朱德明【摘要】目的探讨不同灌注方法在深低温停循环下(DHCA)的脑保护的作用。方法实验动物选用健康白乳猪幼猪(农科院提供)40只。随机分为4组，每组10只。A组：单纯DHCA组;B组：DHCA+逆行性脑灌注(RCP);C组：DHCA+单侧顺行性脑灌注(U-SACP);D组：DHCA+双侧顺行性脑灌注(B-SACP)。对照分析四组组间分别于CPB前(T1)、DHCA后30min(T2)、60min(T3)、90
2、min(T4)和复温再灌注30min(T5)氧摄取率的变化。采用原位末端标记法(TUNEL染色法)观察和测定脑组织神经细胞凋亡的情况。结果与A组相比，B组、C组和D组可显著减少幼猪DHCA后神经细胞凋亡数目(P<0.05),T2、T3和T43个时间窗脑氧摄取率明显低于A组，差异有显著意义(P<0.05)。A组可见明显神经细胞凋亡改变，B组仅见中等程度神经细胞凋亡改变,C组和D两组见少量神经细胞凋亡改变,A组与B组,C组和D组、B组与C组和D组差异具统计学意义(P<0.05)，但是C组
3、和D组差异没有统计学意义(P>0.05)。结论SACP与RCP脑保护作用均优于DHCA，U-SACP与B-SACP脑保护作用好于RCP，但是两者差距没有统计学意义。【关键词】深低温停循环;顺行性脑灌注;逆行性脑灌注;体外循环 Abstract:OBJECTIVEToevaluatetheprotectiveeffectofdifferentperfusionduringdeephypothermiccirculatoryarrest(DHCA).METHODSFourtyhealthybaby
4、pigswererandomlydividedintofourgroups(10pigspergroup).GrouupA：simpleDHCA,GroupB：DHCA+retrogradecerebralperfusion(RCP),GroupC：DHCA+unilateralselectiveantegradecerebralperfusion(U-SACP),GroupD：DHCA+bilateralselectiveantegradecerebralperfusion(B-SACP).Meas
5、ureoxygenenhancementratio(OER)frombloodwhichweretakenindifferentwindowaroundDHCA.NeuralapoptosiswasidentifiedbyTUNELinthebrain.ComparelyanalysisthechangeofOERandthedepressionofneuralapoptosisinthebrainamongfourgroupswasperformed.RESULTSOERlevelsweresign
6、ificantlydifferenceatpostDHCA30min(T2),60min(T3),90min(T4)betweengroupAandgroupB,C,D(P<0.05).ThenumberofneuralapoptosiccellsingroupB,C,DweredecreasedsignificantlyduringDHCA(P<0.05).ThelevelofapoptosiccellsingroupBwasmuchhigherthanthatingroupCandD(
7、P<0.05),whilethatingroupCwasthesameasthegroupD(P>0.05).CONCLUSIONDHCA+RCPandDHCA+SACParemorebotheffectivemethodsthanDHCAoncerebralprotectionwhilethelatterismoresuitable.U-SACPandB-SACParebetterthanDHCA+RCP,buttherewasnodifferencebetweengroupCandD.
8、5 Keywords：Deephypothermiccirculatoryarrest;Selectiveantegradecerebralperfusion;Retrogradecerebralperfusion;Cardiopulmonarybypass深低温停循环(deephypothermiccirculatoryarrest,DHCA)是婴幼儿复杂先天性心脏病的重要技术，它可以保护大脑承受短时的缺血、缺氧，提供一个无血的手术环境。虽然手术与监
