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find Keyword "脑保护" 16 results
  • 深低温停循环重力脑逆行灌注在主动脉瘤手术中的脑保护作用

    目的 探讨深低温停循环重力脑逆行性灌注技术在主动脉夹层动脉瘤手术中对脑和脊髓的保护作用。方法 建立体外循环后,开始降温。肛温17℃时,患者深度头低位(deep trendelenburg position)。控制股静脉回流, 股动脉流量降至1.5 L/min,升高和维持中心静脉压在20~23 cmH2O(1kPa=10.2 cmH2O),即可完成脑逆行性灌注。结果 本组2例患者停循环脑逆行性灌注时间分别为50分钟和116分钟,术后未发生神经系统并发症。结论 深低温停循环重力脑逆行性灌注技术操作简单,能够充分暴露术野,对脑和脊髓有很好的保护作用。

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
  • Research progress of antegrade cerebral perfusion and retrograde cerebral perfusion in aortic arch surgery

    Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are the two major types of brain protection during aortic arch surgery. Which one is better has still been debated. By summarizing and analyzing the research progress of the comparative research of antegrade cerebral perfusion and retrograde cerebral perfusion in aortic arch surgery, we have found that there was no significant difference between ACP and RCP in terms of temporary nerve dysfunction (TND), permanent nerve dysfunction (PND), stroke, early mortality, morbidity, long-time survival, and a composite outcome of hospital death, bleeding, prolonged ventilation, need for dialysis, infection and stroke. But RCP resulted in a high incidence of prolonged mean ICU-stay and hospital-stay, longer mean extubation time as well as higher cost. And the surgeon is given more time to reconstruct the vessels of the arch since mean operative time is longer in the ACP. So we think that antegrade cerebral perfusion might be preferred as the brain protection method for complicated aortic arch procedures. If a surgeon confirms that the surgery is not very sophisticated and can be completed in a short time, it is better to choose RCP because of no catheter or cannula in the surgical field to impede the surgeon. The article aims at providing a reference to cardiac surgeries when choosing cerebral protection strategy in aortic arch surgery.

    Release date:2017-06-02 10:55 Export PDF Favorites Scan
  • 吸入麻醉药与脑保护的研究进展

    围手术期间由于手术本身的影响以及血流动力学变化可以导致全身各个系统、器官特别是脑缺血等损伤,因此对大脑等重要器官的保护是临床重要课题。围麻醉期间所使用的吸入麻醉剂很早就被报道有器官保护作用,大量动物实验已经证实吸入麻醉药的预处理和后处理有脑保护作用。其脑保护作用机制主要涉及调节钙离子浓度,降低谷氨酸盐的神经毒性,抑制N-甲基-D-天冬氨酸受体活性等。现对吸入麻醉药脑保护作用的不同影响因素及可能的作用机制进行综述。

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  • Research Progress of Cerebral Protection Strategy in Aortic Arch Surgery for Adults——Moderate Hypothermic Circulatory Arrest with Selective Antegrade Cerebral Perfusion

    Increasing evidences show that a gradual trend away from deep hypothermia toward moderate hypothermic circulatory arrest, which has been proved to be safe and effective in clinic. By summarizing and analyzing the research progress and applying status of the moderate hypothermia circulatory arrest with selective antegrade cerebral perfusion, the article aims at promoting the application of this tenique as a cerebral protection strategy in aortic arch surgery for adults in China.

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  • Application of Selective Cerebral Perfusion in Pediatric Aortic Arch Reconstruction Procedure

    Objective To investigate the efficacy and safety of the application of selective cerebral perfusion (SCP) technique in pediatric aortic arch reconstruction, so as to alleviate brain injury during operation. Methods From April 2007 to May 2008, 32 children aged from 8 days to 103 months (14.4±25.4 months) and weighed from 27 kg to 22.0 kg (6.7±4.4 kg) underwent aortic arch reconstruction with selective cerebral perfusion in Shanghai Children’s Medical Center. Twentytwo suffered from aortic coarctationwith intracardiac anomaly, and 10 suffered from interrupted aortic arch with intracardiac anomaly. The arterial cannulation was achieved by placing a flexible wire wound cannula in ascending aorta close to the root part of innominate artery. The rectal temperature was about 1820℃. Then the cannula was moved upward into innominate artery to perform SCP. Results The time of SCP was 17-121 mins(39.6±19.4 mins), perfusion blood flow maintained in 15-40 ml/(kg·min)[29.7±6.1 ml/(kg·min)]. Four cases died of low cardiac output syndrome or arrhythmia, and no evidence of brain injury was observed. No obvious neurologic complication was observed in 28 survivls. No abnormal electroencephalogram was observed in 25 cases. The results of head Bsonography and brain magnetic resonance image (MRI) were normal in 5 neonates. Conclusion Selective cerebral perfusion is a simple, feasible, safe and effective technique in pediatric aortic arch reconstruction.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Effects of Inflammatory Reaction Related to Different Cerebral Protective Methods on Brain

    Objective To observe the changes of inflammatory cytokines in brain protective methods, study the inflammatory mechanism during cerebral protection tissues in different cerebral Methods Eighteen healthy adult dogs were randomly divided into three groups (6 dogs in each group): normothermic cardiopulmonary bypass (NCPB group), deep hypothermic circulatory arrest (DHCA group), and intermittent selective antegrade cerebral perfusion (ISACP) during DHCA(DHCA+ISACP group). After operation the water contents in brain tissue were measured ,the hippocampus were removed, and radio-immunity analysis (RIA) was used to measure the content of interleukin-1β(IL-1β) and tumor necrosis factor-alpha (TNF-α) of the hippocampus tissue. The morphology of the hippocampus were examined by transmission electron (TE) microscopy. Results The contents of IL-1β and TNF-α of DHCA group was higher significantly than those of NCPB group and DHCA+ISACP group (P〈0.01), there was no significant difference between NCPB group and DHCA+ISACP group (P〉0.05). And the contents of TNF-α and IL-1β were positive linear correlated with degree of edema of brain tissues (r = 0. 987, 0.942; P〈 0.01). TE examination revealed that the damage of the uhrastructure in the DHCA group was more severe than that in NCPB group and DHCA+ISACP group. Conclusions This experiment revealed that long duration DHCA can bring some damages to the brain and that ISACP during long-term DHCA has brain protective effects to some extent. IL-1β and TNF-α play an effective role in the brain damage of long-term DHCA.

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 远端缺血预处理对脑缺血保护作用的研究进展

    远端缺血预处理可以诱导脑缺血耐受形成从而产生脑保护作用,具有很强的临床应用价值。其可通过机体不太重要的器官的缺血预处理来保护重要器官如脑、心脏、肺、小肠、胃、肝等,其脑保护机制可能与内源性一氧化氮、丝裂原活化蛋白激酶通道、Notch信号、热应激蛋白70表达、抗氧化作用、抑制神经元凋亡、神经和(或)体液因素等有关。现对远端缺血预处理对脑缺血保护作用相关机制的研究现状作一综述。

    Release date:2016-09-07 02:34 Export PDF Favorites Scan
  • 冷脑保护液对大脑皮层组织丙二醛、血栓素A2及前列环素的影响

    目的 研究深低温停循环间断灌注充氧脑保护液对大脑皮层组织丙二醛(MDA)、血栓素A2(TXA2)及前列环素(PGI2)的影响.方法 杂种犬10条,随机均分为两组.A组:单纯深低温停循环120分钟;B组:深低温停循环后间断灌注充氧脑保护液.两组动物分别于不同时相测定大脑皮层组织MDA,TXA2的代谢产物血栓素B2(TXB2)及PGI2代谢产物6-Keto-PGF1a的含量. 结果 恢复循环45分钟后,A组MDA和TXB2含量明显高于心肺转流术前(P<0.01),6-Keto-PGF1a含量明显低于B组(P<0.01). 结论 深低温停循环间断灌注充氧脑保护液能明显减少恢复循环后大脑皮层组织MDA和TXA2的生成,增加PGI2的生成,发挥其对大脑皮层组织的保护作用.

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
  • Hyperoxia Management During Deep Hypothermia for Cerebral Protection in a Circulatory Arrest Rabbit Model

    Abstract: Objective To investigate the cerebral protective effects of hyperoxia management during deep hypothermia circulatory arrest(DHCA) rabbit by the blood gas indexes, superoxide dismutase( SOD) activity and malondialdehyde (MDA) levels of brain, and ratio of water to brain. Methods A DHCA and antegrade selective cerebral perfusion (ASCP) rabbit model was established. Twenty-four 11-13 week-old male New Zealand rabbits( weighing 2.7 to 3.4 kg) were assigned to three groups with a random number table: a sham operation group (Sham group), an ASCP group (S group), and an ASCP + hyperoxia management group (SH group). There were eight rabbits in each group. We recorded the intraoperative values for arterial oxygen pressure (PaO2), arterial oxygen saturation (SaO2), jugular venous oxygen pressure(PjvO2), jugular venous oxygen saturation( SjvO2) and blood lactate level. The brain SOD activity, MDA levels, and ratio of water to brain were measured after the operation. Results Before initiating circulatory arrest, before initiating reperfusion and five minutes of reperfusion, levels of PaO2 , PjvO2 , and SjvO2 in the SH group were significantly higher than those of the S group and Sham group. SOD activity in the SH group was not significantly different from that of the S group[(213.53±33.52) U/mg. prot vs. (193.02±27.67) U/mg. prot] and Sham group[(213.53±33.52) U/mg. prot vs.(244.38±35.02)U/mg. prot], but the SOD activity in the S group was lower than that in the Sham group( P < 0.05). MDA levels in the SH group were lower than that in the S group[(1.42±0.30) nmol/mg. prot vs. (2.37±0.55) nmol/mg. prot, P < 0.05]. Conclusion Our data show that hyperoxia management during DHCA+ASCP improves rabbits’PjvO2 and SjvO2, maintains brain SOD activity, and decreases brain MDA levels, demonstrating the neuroprotective effects of hyperoxia mangagement.

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • Cerebral Protection During Deep Hypothermic Circulatory Arrest by Retrograde Cerebral Perfusion

    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...

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
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