• 1. 北京協(xié)和醫(yī)學(xué)院 中國醫(yī)學(xué)科學(xué)院 阜外心血管病醫(yī)院 心血管病研究所 體外循環(huán)科;;
  • 2. 動物實驗中心;;
  • 3. 麻醉科，北京 100037;;
  • 4. 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院 心血管外科，北京 100029;

目的 通過研究深低溫期間高氧血氣管理對深低溫停循環(huán)（DHCA）兔血氣、生化指標(biāo)、腦組織中超氧 化物歧化酶（SOD）活性、丙二醛（MDA）含量、腦組織含水量的影響，探討高氧管理的腦保護(hù)作用。 方法 建立兔 DHCA ＋選擇性腦灌注（ASCP）動物模型，將24 只11 ～ 13 周齡雄性新西蘭兔（體重2.7 ～ 3.4 kg）用隨機數(shù)字表法 分為3 組：假手術(shù)組（Sham 組），ASCP 組（S 組），ASCP ＋高氧管理組（SH 組），每組8 只。術(shù)中檢測動脈血氧分 壓（PaO2）、動脈血氧飽和度（SaO2）、頸靜脈球血氧分壓（PjvO2）、頸靜脈球血氧飽和度（SjvO2）和血乳酸（Lac）含量，術(shù) 后檢測腦組織SOD 活性、MDA 含量和腦組織含水量。 結(jié)果 停循環(huán)前、復(fù)灌前和復(fù)灌5 min SH 組PaO2、PjvO2 和 SjvO2 均高于S 組和Sham 組（P ＜ 0.05）。SH 組腦組織SOD 活性與S 組[（213.53±33.52） U/mg.prot vs. （193.02 ±27.67） U/mg.prot] 和Sham 組[（213.53±33.52） U/mg.prot vs.（244.38±35.02）U/mg.prot] 比較差異 無統(tǒng)計學(xué)意義（P＞0.05），但S組SOD活性低于Sham組（P＜0.05）。SH組腦組織MDA含量低于S組[（1.42±0.30） nmol/mg.prot vs.（2.37±0.55） nmol/mg.prot，P ＜ 0.05]。 結(jié)論 深低溫期間的高氧血氣管理在DHCA ＋ ASCP 中能提供更好的氧供，有效地提高兔PjvO2 和SjvO2，維持腦組織SOD 活性，降低MDA 含量，具有腦保護(hù)作用。

引用本文： 王茜,楊九光,龍村等. 深低溫期間高氧血氣管理對停循環(huán)兔腦組織的保護(hù)作用. 中國胸心血管外科臨床雜志, 2012, 19(1): 57-61. doi: 復(fù)制

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2. 　Harrington DK, Fragomeni F, Bonser RS. Cerebral perfusion. Ann Thorac Surg, 2007,83(2)：S799-S804.
3. 　楊九光, 龍村, 姚忠喜, 等．經(jīng)右鎖骨下動脈、右房插管兔體外循環(huán)及選擇性腦灌注模型的建立．中華實驗外科雜志, 2000,17(1)：77-78.
4. 　楊九光, 龍村, 孫立忠, 等．全主動脈弓置換術(shù)中的溫度管理．中國胸心血管外科臨床雜志, 2005,12(5)：312-315.
5. 　田良鑫, 孫立忠, 程衛(wèi)平, 等. 單側(cè)與雙側(cè)順行性腦灌注對認(rèn)知能力的影響. 中國胸心血管外科臨床雜志, 2005,12(1)：8-10.
6. 　Joachimsson PO, Sjöberg F, Forsman M, et al．Adverse effects of hyperoxemia during cardiopulmonary bypass．J Thorac Cardiovasc Surg, 1996, 112(3)：812-819.
7. 　Dexter F, Kern FH, Hindman BJ, et al．The brain uses mostly dissolved oxygen during profoundly hypothermic cardiopulmonary bypass. Ann Thorac Surg, 1997, 63(6)：1725-1729.
8. 　Nollert G, Nagashima M, Bucerius J,et al．Oxygenation strategy and neurologic damage after deep hypothermic circulatory arrest. Ⅰ.Gaseous microemboli. J Thorac Cardiovasc Surg, 1999,117(6)：1166-1171.
9. 　Leyvi G, Bello R, Wasnick JD, et al．Assessment of cerebral oxygen balance during deep hypothermic circulatory arrest by continuous jugular bulb venous saturation and near-infrared spectroscopy. J Cardiothorac Vasc Anesth, 2006, 20(6)：826-833.
10. 　Cormio M, Valadka AB, Robertson CS．Elevated jugular venous oxygen saturation after severe head injury．J Neurosurg , 1999, 90(1)：9-15．.
11. 　Croughwell ND, Newman MF, Blumenthal JA, et al．Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass. Ann Thorac Surg,1994, 58(6)：1702-1708.
12. 　Young C，Tenkova T, Dikranian k，et a1．Excitotoxic versus apoptotic mechanisms of neuronal cell death in perinatal hypoxia／ischemia．Curr Mol Med，2004, 4(2)：77-85．.
13. 　Liu Y, Rosenthal RE, Haywood Y, et al．Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome. Stroke, 1998, 29(8)：1679-1686.
14. 　Kilgannon JH, Jones AE, Shapiro NI, et al．Association between arterial hyperoxia following resuscitation from cardiac arrest and inhospital mortality. JAMA, 2010, 303(21)：2165-2171.
15. 　McCord JM, Fridovich I．Superoxide dismutase. J Biol Chem, 1969, 244(22)：6049-6055.
16. 　Lewén A, Matz P, Chan PH．Free radical pathways in CNS injury. J Neurotrauma, 2000, l7(10)：871-890.
17. 　Kamada H, Yu F, Nito C, et al．Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats：relation to blood-brain barrier dysfunction. Stroke, 2007,38(3)：1044-1049.
18. 　Maier CM, Hsieh L, Crandall T, et al．Evaluating therapeutic targets for reperfusion-related brain hemorrhage. Ann Neurol, 2006, 59(6)： 929-938.
19. 　Narasimhan P, Liu J, Song YS, et al．VEGF stimulates the ERK 1/2 signaling pathway and apoptosis in cerebral endothelial cells after ischemic conditions. Stroke, 2009, 40(4)： 1467-1473.
20. 　祝忠群, 朱德明, 蘇肇伉, 等．先天性心臟病兒體外循環(huán)的再氧合損傷．中國體外循環(huán)雜志, 2005,3(3)：131-133.
21. 　Pearl JM, Thomas DW, Grist G, et al．Hyperoxia for management of acid-base status during deep hypothermia with circulatory arrest. Ann Thorac Surg, 2000，70(3)：751-755.
  1. 1. 　Griepp RB. Cerebral protection during aortic arch surgery．J Thorac Cardiovasc Surg, 2001, 121(3)：425-427.
  2. 2. 　Harrington DK, Fragomeni F, Bonser RS. Cerebral perfusion. Ann Thorac Surg, 2007,83(2)：S799-S804.
  3. 3. 　楊九光, 龍村, 姚忠喜, 等．經(jīng)右鎖骨下動脈、右房插管兔體外循環(huán)及選擇性腦灌注模型的建立．中華實驗外科雜志, 2000,17(1)：77-78.
  4. 4. 　楊九光, 龍村, 孫立忠, 等．全主動脈弓置換術(shù)中的溫度管理．中國胸心血管外科臨床雜志, 2005,12(5)：312-315.
  5. 5. 　田良鑫, 孫立忠, 程衛(wèi)平, 等. 單側(cè)與雙側(cè)順行性腦灌注對認(rèn)知能力的影響. 中國胸心血管外科臨床雜志, 2005,12(1)：8-10.
  6. 6. 　Joachimsson PO, Sjöberg F, Forsman M, et al．Adverse effects of hyperoxemia during cardiopulmonary bypass．J Thorac Cardiovasc Surg, 1996, 112(3)：812-819.
  7. 7. 　Dexter F, Kern FH, Hindman BJ, et al．The brain uses mostly dissolved oxygen during profoundly hypothermic cardiopulmonary bypass. Ann Thorac Surg, 1997, 63(6)：1725-1729.
  8. 8. 　Nollert G, Nagashima M, Bucerius J,et al．Oxygenation strategy and neurologic damage after deep hypothermic circulatory arrest. Ⅰ.Gaseous microemboli. J Thorac Cardiovasc Surg, 1999,117(6)：1166-1171.
  9. 9. 　Leyvi G, Bello R, Wasnick JD, et al．Assessment of cerebral oxygen balance during deep hypothermic circulatory arrest by continuous jugular bulb venous saturation and near-infrared spectroscopy. J Cardiothorac Vasc Anesth, 2006, 20(6)：826-833.
  10. 10. 　Cormio M, Valadka AB, Robertson CS．Elevated jugular venous oxygen saturation after severe head injury．J Neurosurg , 1999, 90(1)：9-15．.
  11. 11. 　Croughwell ND, Newman MF, Blumenthal JA, et al．Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass. Ann Thorac Surg,1994, 58(6)：1702-1708.
  12. 12. 　Young C，Tenkova T, Dikranian k，et a1．Excitotoxic versus apoptotic mechanisms of neuronal cell death in perinatal hypoxia／ischemia．Curr Mol Med，2004, 4(2)：77-85．.
  13. 13. 　Liu Y, Rosenthal RE, Haywood Y, et al．Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome. Stroke, 1998, 29(8)：1679-1686.
  14. 14. 　Kilgannon JH, Jones AE, Shapiro NI, et al．Association between arterial hyperoxia following resuscitation from cardiac arrest and inhospital mortality. JAMA, 2010, 303(21)：2165-2171.
  15. 15. 　McCord JM, Fridovich I．Superoxide dismutase. J Biol Chem, 1969, 244(22)：6049-6055.
  16. 16. 　Lewén A, Matz P, Chan PH．Free radical pathways in CNS injury. J Neurotrauma, 2000, l7(10)：871-890.
  17. 17. 　Kamada H, Yu F, Nito C, et al．Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats：relation to blood-brain barrier dysfunction. Stroke, 2007,38(3)：1044-1049.
  18. 18. 　Maier CM, Hsieh L, Crandall T, et al．Evaluating therapeutic targets for reperfusion-related brain hemorrhage. Ann Neurol, 2006, 59(6)： 929-938.
  19. 19. 　Narasimhan P, Liu J, Song YS, et al．VEGF stimulates the ERK 1/2 signaling pathway and apoptosis in cerebral endothelial cells after ischemic conditions. Stroke, 2009, 40(4)： 1467-1473.
  20. 20. 　祝忠群, 朱德明, 蘇肇伉, 等．先天性心臟病兒體外循環(huán)的再氧合損傷．中國體外循環(huán)雜志, 2005,3(3)：131-133.
  21. 21. 　Pearl JM, Thomas DW, Grist G, et al．Hyperoxia for management of acid-base status during deep hypothermia with circulatory arrest. Ann Thorac Surg, 2000，70(3)：751-755.