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Objective To research the reasonable perfusion flow of cardiopulmonary bypass during aortic arch procedure of patients with acute type A aortic dissection.Methods Forty patients suffered from acute Stanford type A aortic dissection had been divided into two groups randomly.Group A named traditional perfusion flow group,group B named modified perfusion flow group.Monitoring cerebral blood flow and cerebral tissue oxygen during deep hyperthermia circulatory arrest and antegrade aelective cerebral perfusion procedure by transcranial doppler(TCD) and near-infrared spectroscopy(NIRS).The concentration of S100 protein and lactic acid was measured at six time point.Results Statistical difference of mean blood flow velocity of MCA had been found between two group 3 min after total flow reperfusion.TOI was more tban 60％ during study in both of groups.S100 protein in group A was significantly higher than group B at T6,T7 and T8.Statistical difference of blood lactic concentration had been found between two groups,(4.88± 1.62) mmol/L in group A,(3.83± 1.48) mmol/L in group B,P ＜ 0.05.Safe consciousness time between two groups was difference,(7.36± 2.86) h in group A and (5.27± 3.11) h in group B,P ＜ 0.05.Conclusion Compared with the traditional perfusion flow,modified perfusion flow can provide sufficient cerebral perfusion and prevent the luxury perfusion.
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Objective To determine whether polarized arrest using adenosine and lidocaine cold crystalloid cardioplegia would give satisfactory myocardial protection in the cardiac surgery of experimental animals.Methods Twelve pigs were randomized divided into 2 groups (n =6) to receive adenosine-lidocaine cardioplegia or St.Thomas cardioplegia.Left ventricular systolic and diastolic function,cardiac output,cardiac troponin 1 were monitored at before operation (T1),1 hour after crossclamp was removed (T2) and 2 hours after cross-clamp was removed (T3).After T3 the left ventricular ultrastructure was observed,mitochondrial ultrastructure was analyzed by CMIAS image system.Results There were no statistical differences between the two groups in T1.The left ventricular systolic pressure,± dp/dt and cardiac output in adenosine-lidocaine group wasmuch higher than St.Thomas group in T2 and T3,meanwhile the left ventricular diastolic pressure,capillary wedge pressureand cardiac troponin Ⅰ value was lower than St.Thomas group.The hemodynamic values was more stable in adenosine-lidocaine group.St.Thomas group got more myocardial injury alterations in intracellular structure than adenosine-lidocaine group.The image analysis of mitochondrial ultrastructure shows St.Thomas group got lower shape factor,higher area density and perimeter density compared with baseline and adenosine-lidocaine group values.Conclusion Adenosine-lidocaine cold crystalloid car-dioplegia gave satisfactory cardiac arrest,got better myocardial protection than St.Thomas cardioplegia.
ABSTRACT
Objective To investigate the effect and safety of different PaO2 to the reoxygenation injury of cyanotic congenital heart disease through controlling the FiO2 when initiating cardiopulmonary bypass (CPB).Methods Thirty patients with cyanotic congenital heart disease were divided into 3 equal groups according the PaO2 when initiating cardiopulmonary bypass:group 1 (G1,PaO2 ＜ 120 mm Hg) ; group 2 (G2,PaO2 120-180 mm Hg),group 3 (G3,PaO2 180-250 mm Hg),and ten patients with acyanotic congenital heart disease were group 4 (G4,PaO2 ＞ 200 mm Hg).Serum CK-MB,cTnI,IL-6,TNF-α,SOD,8-ISO and S100β were measured before CPB、5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours and 24 hours post operation with intemal jugular vein blood samples.Clinical results were also recorded.Results CK-MB,cTnI,IL-6,TNF-α,8-ISO and S100β3 were all normal without significant differences between them before CPB.After initiation of CPB,their levels in all groups increased,reached the peak before or after the stop of CPB,then gradually declined.At each time point,the levels of these indexes were G3 ＞ G2 ＞ G1 ＞ G4 with significant difference between them (P ＜ 0.05) ; The serum SOD levels of G4 were higher than the other three groups with significant difference(P ＜ 0.05).They all declined after initiation of CPB,reached lowest after cross clamp releasing,then gradually increased.At 5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours post operation,there were significant differences between four groups (P ＜ 0.05),and at 24 hours post operation,the SOD levels of G4 were higher than the other three groups with significant difference (P ＜ 0.05).There were no significant difference between G1,G2 and G3 in SvO2,Lac,positive vasoactive drugs、ventilation time and ICU time.All patients were alive.Conclusion Low reoxygenation concentration can reduce the reoxygenation injury of cyanotic congenital heart disease,though there may be some potential influence to cerebral oxygen metabolism.Further studies about oxygen supplymethodsare necessary in deep hypothermia and long-time CPB.