深低温停循环下脑保护液的实验研究
摘要
目的：随着心血管外科技术的不断发展，脑保护问题日显突出。目前常用的脑保护方法深低温停循环(DHCA)，深低温停循环选择性脑灌注(DHCA-SCP)，深低温停循环逆行脑灌注(DHCA-RCP)各有其自身的局限性。本研究旨在为临床工作提供一种较为理想的脑保护方法。方法：犬升主动脉右心房插管建立体外循环，降温到鼻咽温18℃时停循环。对照组单纯DHCA 120分钟，实验组于停循环后，经双侧颈动脉灌注充氧脑保护液。首次剂量为25ml／kg，以后每隔30分钟灌注一次，灌注量为12.5ml／kg。对照组及实验组均于停循环120分钟后恢复循环并复温。两组动物分别于体外循环(CPB)前，停循环120分钟后及恢复循环45分钟后经预先开窗的颅顶部取大脑皮层组织测定其ATP，MDA，TXB2，6-Keto-PGF_(1α)的含量，用NADPH-黄递酶染色法测定其NADPH阳性细胞的数量，并作透射电镜的检查。结果：DHCA 120分钟及恢复循环45分钟后，实验组大脑皮层组织ATP的含量均明显高于对照组(P＜0.05及P＜0.01)。DHCA 120分钟后，大脑皮层组织MDA，TXB2及6-Keto-PGF_(1α)的含量两组均没有明显差异(P＞0.05)，恢复循环45分钟后，对照组大脑皮层组织MDA的含量及TXB_2的含量均明显高于实验组(P＜0.001及P＜0.05)，对照组大脑皮层组织6-Keto-PGF_(1α)的含量明显低于实验组(P＜0.01)。DHCA120分钟后，对照组大脑皮层组织NADPH阳性神经细胞的数量明显多于CPB前(P＜0.05)，恢复循环45分钟后，其数量进一步增加，与DHCA 120分钟后比较，P＜0.01。实验组无此变化。透射电镜检查显示对照组大脑皮层组织于DHCA 120分钟及再灌注45分钟后出现明显异常，线粒体肿胀，嵴断裂，空泡形成，线粒体膜结构破坏等。实
OBJECTIVE: With the development of the technique of cardiovascular surgery, the problem of cerebral protection is becoming more and more important. At present the method of cerebral protection common used such as deep hypothermic circulatory arrest(DHCA), DHCA selective cerebral perfusion (DHCA-SCP), DHCA retrograde cerebral perfusion (DHCA-RCP) has its own disadvantage respectively. The purpose of the present study was to provide an optimal method of cerebral protection for the clinical application. METHOD: Ten mongrel dogs were divided into two groups, which were placed on CPB via the ascending aorta and right atrium, cooled to a nasopharyngeal temperature of 18°C and submitted 120 minutes of total circulatory arrest. 5 dogs in the control group did not receive cerebralplegia and 5 dogs in the experimental group received oxygenated cerebralplegic infusion through the bilateral common carotid arteries. The dosage of the cerebralplegic infusion was 25ml/kg bodyweight at the onset of arrest, followed by 12.5ml/kg at 30-minute intervals during the arrest period. All animals were re-established the CPB and rewanned after 120 minutes of circulatory arrest. Cerebral cortex was collected to study adnosine triphosphate(ATP), malondialdehyde(MDA), thromboxane B_2(TXB_2), 6-Keto-PGF_(1α), nitric oxide synthase(NOS) and ultrastructure at the time point of pre-CPB, 120 minutes of circulatory arrest and at 45 minutes of reperfusion in all animals. RESULTS: The level of ATP in the experimental group is higher significantly than that in the control group at 120 minutes of circulatory
OBJECTIVE: With the development of the technique of cardiovascular surgery, the problem of cerebral protection is becoming more and more important. At present the method of cerebral protection common used such as deep hypothermic circulatory arrest(DHCA), DHCA selective cerebral perfusion (DHCA-SCP), DHCA retrograde cerebral perfusion (DHCA-RCP) has its own disadvantage respectively. The purpose of the present study was to provide an optimal method of cerebral protection for the clinical application. METHOD: Ten mongrel dogs were divided into two groups, which were placed on CPB via the ascending aorta and right atrium, cooled to a nasopharyngeal temperature of 18°C and submitted 120 minutes of total circulatory arrest. 5 dogs in the control group did not receive cerebralplegia and 5 dogs in the experimental group received oxygenated cerebralplegic infusion through the bilateral common carotid arteries. The dosage of the cerebralplegic infusion was 25ml/kg bodyweight at the onset of arrest, followed by 12.5ml/kg at 30-minute intervals during the arrest period. All animals were re-established the CPB and rewanned after 120 minutes of circulatory arrest. Cerebral cortex was collected to study adnosine triphosphate(ATP), malondialdehyde(MDA), thromboxane B_2(TXB_2), 6-Keto-PGF_(1α), nitric oxide synthase(NOS) and ultrastructure at the time point of pre-CPB, 120 minutes of circulatory arrest and at 45 minutes of reperfusion in all animals. RESULTS: The level of ATP in the experimental group is higher significantly than that in the control group at 120 minutes of circulatory
引文
1. Griepp RB. Strategies for cerebral protection during aortic aneurysm surgery. The international symposium on current techniques for brain protection in aortic surgery. Japan. 1996.p18.
2. Hidetoshi Akashi, Keiichiro Tayama,YUji Hanamoto,et al. Brain protection for aortic arch replacement; Significance of monitoring SJO2 and RSO2 in antegrade selective cerebral perfusion. The international symposium on current techniques for brain protection in aortic surgery. Japan. 1996.p64.
3. Svensson LG, Grawford ES, Hess KR, et al. Deep hypothermic with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993,106:19.
4. Mashfood S, Dazi A, Garcia J,et al. Management of aortic arch aneurysm using profound hypothermic and circuIatory arrest. Ann Thorac Surg, 1985,39:412.
5．梅运清，宋龙生，周久华。低温心脏手术时脑保护的研究现状与展望。昆明医学院学报，1995，16：61．
6. Akihiko U, Toshiro H, Mamabu H, et al. Retrograde cerebral perfusion through a superior vena cava. Ann Thorac Surg, 1992,53:47.
7. Filgueiras CL, Winsborrow B, Ye J, et al. A magnetic resonance study of antegrade and retrogrde cerebral perfusion during aortic arch surgery in pigs. J Thorac Cardiovas Surg, 1995,110:55.
8．马大青，吴新民，周源。体外循环降温法深低温停循环的研究进展。国外医学麻醉学与复苏分册。1995，16：278．9. Drummond JC. Brain protection during anesthesia. Anesthesiology, 1993,79: 877.
10．单国瑾，王东信，吴新民，等。利多卡因对逆性脑灌注脑保护的影响。中华麻醉学杂志，1997,17：734．
11. Robbins RC, Balaban RS, Swain JA, et al. Intennittent hypothennic asanguinous cerebral perfusion(cerebroplegia) protects the brain during prolonged circulatory arrest. J Thorac Cardiovasc Surg 1990,99:878.
12．杜洪印，岳云。低温脑复苏机理探讨。国外医学麻醉学与复苏分册。1995，16：84．
13. Konyas HA, Wei EP, Ellis EF, et al. Appearance of superoxide anion radical in cerebral extrcellular space during increased prostaglandin synthesis in cats. Circ Res, 1985,7:142.
14. Tegtmeimer F, Weber C, Heister U, et al. Eicosanoids in rat brain during ischemia and reperfusion. J Cereb Flow Metab, 1990,13:358.
15. Leffier CW, Mirro R, Armstead WM, et al. Prostanoid synthesis and vascular response to exogenous arachidonic following cerebral ischemic in piglets. Prostaglandins, 1990,40:241.
16. Faraci FM, Brain JE. Nitric Oxide and cerebral circulation. Stroke,1994,25:692.
17. Segawa D, Hatori N, Yoshizu H, et al. The effect of nitric oxide synthase inhibitor on reperfusion injury of the brain under hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 1998,115:925.
18．许长庆，夏作理，史义菊，等。脑缺血后脑组织NO含量和NOS活性变化及三七总皂甙的影响，中国神经精神疾病杂志，??1997,23:77.
19. Bredt DS, Glatt CE, Hwang PM, et al., Nitric oxide synthase protein and mRAN are discretely localized in neuronal populations of the mamalian CNS together with NADPH diaphorase. Neuron, 1991,7:615.
20. Bredl DS, Ferris CD, Snyder SH. Nitric oxide synthase regulatory siles: phosphorylation bycyclic AMP dependent protein kinase, protein kinase C, and calcium/calmoudlin binding sites. J Biol Chem,1992,267:10976.
21. Lipton SA, Choi YB, Pan ZH, et al. A redoxbased mechanism for neuroprotective and neurodestructive effects of nitric oxide and its compounds. Nature,1993,364,632.
22. Genaro AM, Hortelano S, Alvarez A, et al. Splenic B lymphocyte programmed cell death is prevented by nitric oxide release tlrough mechanisms involving subtained BcL-2 levels. J Clin Invest, 1995,95:1884.
23. Tseng EE, Brock MV, Langes MS,et al. Neuronal nitric oxide synthase inhibition reduces neuronal apoptosis after hypothennic circulatory arrest. Ann Thorac Surg,1997,64:1639.
24．吴其夏主编。体液因素和血液循环病理生理学。中国协和医科大学联合出版社。1991．P312．
25. Winkler SR, Munoz RL. Mechanism of action of mannitol. Surg Neurol, 1995,43:59.
26. Suzuki J, Imaizumi S, Kayama T, et al. Chemiluminescence in hypoxicbrain: cerebral protective effect of mannitol, Vitamin E and??glucocorticoid. Stroke, 1985,16:695.1. Griepp RB. Strategies for cerebral protection during aortic aneurysm surgery. The international symposium on current teclmiques for brain protection in aortic surgery. Japan. 1996.p18.
2. Lassen NA, Astrup J.cerebrovascular Physiology. New York: Springer-verlag. 1985.p75.
3. Greeley WJ, Ungerleider RM, Smith LR, et al. The effects of deep hypothermic CPB and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg,1989,97:737.
4. Tanaka J, Shiki K, Asou T, et al. Cerebral autoregulation during deep hypothermia nonpulsatile cardiopulmonary bypass with selective perfusion in dogs. J Thorac Cardiovasc Surg, 1988,95:124.
5．马大青，吴新民，周源。体外循环降温法深低温停循环的研究进展。国外医学麻醉学与复苏分册。1995；16：278．
6. Drummond JC. Brain protection during anesthesia. Anesthesiology, 1993,79:877.
7. Small DL, Buchan AM. Mechanism of cerebral ischemia: Intracellular casecades and therapeutic interventions. J Cardiothoracic and Vascular Anesthesia, 1996,10:139.
8. Chan PH, Schmidley JW, Fishman RA, et al. Brain injury, edema and permibility changes induced by oxygen derived free radicals. Neurol, 1984,34:315.
9．任振，丁文祥，苏肇伉．深低温停循环手术中脑组织氧自由基变化的实验研究．中华胸心血管外科杂志，1993，9：357．10. Konyas HA, Wei EP, Ellis EF, et al. Appearance of superoxide anion radical in cerebral extrcellular space during increased prostaglandin synthesis in cats. Circ Res,1985,57:142.
11. Redmound JM, Gillinov AM, Zeher KJ, et al. A mechanism of neurologic injury associated with hypothermic circulatory arrest. J Thorac Cardiovasc Surg,1994,107:776.
12. Faraci FM, Brain JE. Nitric oxide and cerebral circulation. Stroke,1994,25:692.
13. Bredt DS, Glatt CE, Hwang PM, et al. Nitric oxide synthase protein and mRAN are discretely localized in neuronal populations of the mamalian CNS together with NADPH diaphorase. Neuron, 1991,7:615
14. Segwa, Hatori , Yoshizu, et al. The effect of nitric oxide synthase inhibitor on reperfusion injury of the brain under hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 1998,115: 925.
15.Lipton SA, Choi YB, Pan ZH, et al. A redoxbased mechanism for neuroprotective and neurodestructive effects of nitric oxide and its compounds. Nature. 1993,364:632.
16. Genaro AM , Hortelano S, Alvarez A, et al. Splenic B lymphocyte programmed cell death is prevented by nitric oxide release through mechanisms involving subtained BcL-2 levels. J clin Invest,1995;95:1884.
17. Tseng EE, Brock MV, Langes MS,et al. Neuronal nitric oxide synthase inhibition reduces neuronal apoptosis after hypothermic circulatory arrest,Ann Thorac Surg, 1997,64; 1639.
18. Lera LS, Mcnamara JO. Ionotropic glutamate receptor subtypes??activate c-fos transcription by distinet calcium requiring intracellar signaling pathways. Neuron, 1993,10:31.
19. Jorgenser MB, Deckert J, Wright DC, et al. Delayed c-fos proto-oncogene expression in the rat hippocampus induced by transient global cerebral ischemia. Brain Res,1989,484:393.
20. Paula MB, James M, Peter AS, et al. Immediate-early gene expression inovine brain after cardiopulmonary bypass and deep hypothermic circulatory arrest. Anesthesiology,1996,85:1439.
21. Paula MB, Dermot PH, William RR, etal. Immediate-early gene expression inovine brain after hypothermic circulatory arrest: Effects of aptiganel. Ann Thorac Surg,1997, 64:1082.1. Hidetoshi Akashi, Keiichiro Tayama,YUji Hanamoto,et al. Brain protection for aortic arch replacement: Significance of monitoring SJO2 and RSO2 in antegrade selective cerebral perfusion. The international symposium on current techniques for brain protection in aortic surgery. Japan. 1996.p64.
2. Craig K, Mezrow MS, Medulla PS, et al. Evaluation of cerebral metabolism and quantitative electrocephalography after hypothermic circulatory arrest and low flow CPB at different temperatures. J Thorac Cardiovasc Surg, 1994,107:1006.
3. Svensson LG, Grawford ES, Hess KR, et al. Deep hypothermic with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993,106:19.
4. Mashfood S, Dazi A, Garcia J, et al. Management of aortic arch aneurysm using profound hypothermic and circulatory arrest. Ann Thorac Surg,1985,39:412.
5. Greeley WJ, Ungerleider RM, Smith LR, et al. The effects of deep hypothermic CPB and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg, 1989,97:737.
6. Krauce GS, White BE, Aust SD, et al. Brain cell death following ischemia and reperfusion: a proposed biochemical sequence. Crit Care Med,1988,16:714.
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11．梅运清，宋龙生，周久华。低温心脏手术时脑保护的研究现状与展望。昆明医学院学报，1995，16：61．
12. Urayama H, Katada S, Takemura H, et al. Brain disfunction after operation of aortic arch aneurysm. Kyobu Geda, 1992,45:951.
13. Griepp RB. Strategies for cerebral protection during aortic aneurysm surgery. The international symposium on current techniques for brain protection in aortic surgery. Japan.1996. p18.
14. Ueda Y, Miki S, Okila Y, et al. The protective effects of continuous RCP on the central nervous system during deep hypothermic systemic circulatory arrest. Nippon Kyobu Gakkai Zasshi, 1993,41:559.
15. Akihiko U, Toshiro H, Mamabu H, et al. Retrograde cerebral perfusion through a superior vena cava. Ann Thorac Surg, 1992,53:47.
16. Yamashita C, Nakamura H, Nishikava Y, et al. Retrograde cerebral perfusion with circulatory arrest in aortic arch aneurysms. Ann Thorac Surg,1992,54:566.17. Takimoto S, Matsuta T, Harata M, et al. Distal aortic arch aneurysmmectomy. Ann Thorac Surg, 1993,55:151.
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21．吴其夏主编。体液因素和血液循环病理生理学。中国协和医科大学联合出版社。1991．P312．
22. Robbins RC, Balaban RS, Swain JA, et al. Intermittent hypothennic asanguinous cerebral perfusion(cerebroplegia) protects the brain during prolonged circulatory arrest. J Thorac Cardiovasc Surg, 1990,99:878.
23. Bachet J. Circulatory arrest and protection of the brain during surgery of the aortic arch. The international symposium on current teclmiques for brain protection in aortic surgery.Japan. 1996.34.
2. Hidetoshi Akashi, Keiichiro Tayama,YUji Hanamoto,et al. Brain protection for aortic arch replacement; Significance of monitoring SJO2 and RSO2 in antegrade selective cerebral perfusion. The international symposium on current techniques for brain protection in aortic surgery. Japan. 1996.p64.
3. Svensson LG, Grawford ES, Hess KR, et al. Deep hypothermic with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993,106:19.
4. Mashfood S, Dazi A, Garcia J,et al. Management of aortic arch aneurysm using profound hypothermic and circuIatory arrest. Ann Thorac Surg, 1985,39:412.
5．梅运清，宋龙生，周久华。低温心脏手术时脑保护的研究现状与展望。昆明医学院学报，1995，16：61．
6. Akihiko U, Toshiro H, Mamabu H, et al. Retrograde cerebral perfusion through a superior vena cava. Ann Thorac Surg, 1992,53:47.
7. Filgueiras CL, Winsborrow B, Ye J, et al. A magnetic resonance study of antegrade and retrogrde cerebral perfusion during aortic arch surgery in pigs. J Thorac Cardiovas Surg, 1995,110:55.
8．马大青，吴新民，周源。体外循环降温法深低温停循环的研究进展。国外医学麻醉学与复苏分册。1995，16：278．9. Drummond JC. Brain protection during anesthesia. Anesthesiology, 1993,79: 877.
10．单国瑾，王东信，吴新民，等。利多卡因对逆性脑灌注脑保护的影响。中华麻醉学杂志，1997,17：734．
11. Robbins RC, Balaban RS, Swain JA, et al. Intennittent hypothennic asanguinous cerebral perfusion(cerebroplegia) protects the brain during prolonged circulatory arrest. J Thorac Cardiovasc Surg 1990,99:878.
12．杜洪印，岳云。低温脑复苏机理探讨。国外医学麻醉学与复苏分册。1995，16：84．
13. Konyas HA, Wei EP, Ellis EF, et al. Appearance of superoxide anion radical in cerebral extrcellular space during increased prostaglandin synthesis in cats. Circ Res, 1985,7:142.
14. Tegtmeimer F, Weber C, Heister U, et al. Eicosanoids in rat brain during ischemia and reperfusion. J Cereb Flow Metab, 1990,13:358.
15. Leffier CW, Mirro R, Armstead WM, et al. Prostanoid synthesis and vascular response to exogenous arachidonic following cerebral ischemic in piglets. Prostaglandins, 1990,40:241.
16. Faraci FM, Brain JE. Nitric Oxide and cerebral circulation. Stroke,1994,25:692.
17. Segawa D, Hatori N, Yoshizu H, et al. The effect of nitric oxide synthase inhibitor on reperfusion injury of the brain under hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 1998,115:925.
18．许长庆，夏作理，史义菊，等。脑缺血后脑组织NO含量和NOS活性变化及三七总皂甙的影响，中国神经精神疾病杂志，??1997,23:77.
19. Bredt DS, Glatt CE, Hwang PM, et al., Nitric oxide synthase protein and mRAN are discretely localized in neuronal populations of the mamalian CNS together with NADPH diaphorase. Neuron, 1991,7:615.
20. Bredl DS, Ferris CD, Snyder SH. Nitric oxide synthase regulatory siles: phosphorylation bycyclic AMP dependent protein kinase, protein kinase C, and calcium/calmoudlin binding sites. J Biol Chem,1992,267:10976.
21. Lipton SA, Choi YB, Pan ZH, et al. A redoxbased mechanism for neuroprotective and neurodestructive effects of nitric oxide and its compounds. Nature,1993,364,632.
22. Genaro AM, Hortelano S, Alvarez A, et al. Splenic B lymphocyte programmed cell death is prevented by nitric oxide release tlrough mechanisms involving subtained BcL-2 levels. J Clin Invest, 1995,95:1884.
23. Tseng EE, Brock MV, Langes MS,et al. Neuronal nitric oxide synthase inhibition reduces neuronal apoptosis after hypothennic circulatory arrest. Ann Thorac Surg,1997,64:1639.
24．吴其夏主编。体液因素和血液循环病理生理学。中国协和医科大学联合出版社。1991．P312．
25. Winkler SR, Munoz RL. Mechanism of action of mannitol. Surg Neurol, 1995,43:59.
26. Suzuki J, Imaizumi S, Kayama T, et al. Chemiluminescence in hypoxicbrain: cerebral protective effect of mannitol, Vitamin E and??glucocorticoid. Stroke, 1985,16:695.1. Griepp RB. Strategies for cerebral protection during aortic aneurysm surgery. The international symposium on current teclmiques for brain protection in aortic surgery. Japan. 1996.p18.
2. Lassen NA, Astrup J.cerebrovascular Physiology. New York: Springer-verlag. 1985.p75.
3. Greeley WJ, Ungerleider RM, Smith LR, et al. The effects of deep hypothermic CPB and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg,1989,97:737.
4. Tanaka J, Shiki K, Asou T, et al. Cerebral autoregulation during deep hypothermia nonpulsatile cardiopulmonary bypass with selective perfusion in dogs. J Thorac Cardiovasc Surg, 1988,95:124.
5．马大青，吴新民，周源。体外循环降温法深低温停循环的研究进展。国外医学麻醉学与复苏分册。1995；16：278．
6. Drummond JC. Brain protection during anesthesia. Anesthesiology, 1993,79:877.
7. Small DL, Buchan AM. Mechanism of cerebral ischemia: Intracellular casecades and therapeutic interventions. J Cardiothoracic and Vascular Anesthesia, 1996,10:139.
8. Chan PH, Schmidley JW, Fishman RA, et al. Brain injury, edema and permibility changes induced by oxygen derived free radicals. Neurol, 1984,34:315.
9．任振，丁文祥，苏肇伉．深低温停循环手术中脑组织氧自由基变化的实验研究．中华胸心血管外科杂志，1993，9：357．10. Konyas HA, Wei EP, Ellis EF, et al. Appearance of superoxide anion radical in cerebral extrcellular space during increased prostaglandin synthesis in cats. Circ Res,1985,57:142.
11. Redmound JM, Gillinov AM, Zeher KJ, et al. A mechanism of neurologic injury associated with hypothermic circulatory arrest. J Thorac Cardiovasc Surg,1994,107:776.
12. Faraci FM, Brain JE. Nitric oxide and cerebral circulation. Stroke,1994,25:692.
13. Bredt DS, Glatt CE, Hwang PM, et al. Nitric oxide synthase protein and mRAN are discretely localized in neuronal populations of the mamalian CNS together with NADPH diaphorase. Neuron, 1991,7:615
14. Segwa, Hatori , Yoshizu, et al. The effect of nitric oxide synthase inhibitor on reperfusion injury of the brain under hypothermic circulatory arrest. J Thorac Cardiovasc Surg, 1998,115: 925.
15.Lipton SA, Choi YB, Pan ZH, et al. A redoxbased mechanism for neuroprotective and neurodestructive effects of nitric oxide and its compounds. Nature. 1993,364:632.
16. Genaro AM , Hortelano S, Alvarez A, et al. Splenic B lymphocyte programmed cell death is prevented by nitric oxide release through mechanisms involving subtained BcL-2 levels. J clin Invest,1995;95:1884.
17. Tseng EE, Brock MV, Langes MS,et al. Neuronal nitric oxide synthase inhibition reduces neuronal apoptosis after hypothermic circulatory arrest,Ann Thorac Surg, 1997,64; 1639.
18. Lera LS, Mcnamara JO. Ionotropic glutamate receptor subtypes??activate c-fos transcription by distinet calcium requiring intracellar signaling pathways. Neuron, 1993,10:31.
19. Jorgenser MB, Deckert J, Wright DC, et al. Delayed c-fos proto-oncogene expression in the rat hippocampus induced by transient global cerebral ischemia. Brain Res,1989,484:393.
20. Paula MB, James M, Peter AS, et al. Immediate-early gene expression inovine brain after cardiopulmonary bypass and deep hypothermic circulatory arrest. Anesthesiology,1996,85:1439.
21. Paula MB, Dermot PH, William RR, etal. Immediate-early gene expression inovine brain after hypothermic circulatory arrest: Effects of aptiganel. Ann Thorac Surg,1997, 64:1082.1. Hidetoshi Akashi, Keiichiro Tayama,YUji Hanamoto,et al. Brain protection for aortic arch replacement: Significance of monitoring SJO2 and RSO2 in antegrade selective cerebral perfusion. The international symposium on current techniques for brain protection in aortic surgery. Japan. 1996.p64.
2. Craig K, Mezrow MS, Medulla PS, et al. Evaluation of cerebral metabolism and quantitative electrocephalography after hypothermic circulatory arrest and low flow CPB at different temperatures. J Thorac Cardiovasc Surg, 1994,107:1006.
3. Svensson LG, Grawford ES, Hess KR, et al. Deep hypothermic with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg, 1993,106:19.
4. Mashfood S, Dazi A, Garcia J, et al. Management of aortic arch aneurysm using profound hypothermic and circulatory arrest. Ann Thorac Surg,1985,39:412.
5. Greeley WJ, Ungerleider RM, Smith LR, et al. The effects of deep hypothermic CPB and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg, 1989,97:737.
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