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目的研究猴脑缺血后行选择性深低温顺行脑灌注对脑、心肺等全身主要器官的影响。方法成年健康恒河猴8只,动物随机分为二组:选择性深低温组(双侧颈总动脉脉夹闭后低温灌流,n=5),常温组(双侧颈总动脉夹闭,n=3)。常温下临时夹闭双侧颈总动脉10min后,选择性深低温组经右颈内动脉灌流2℃林格氏液,右颈内静脉回流,降低脑温至18℃,维持60min后,开放夹闭的颈总动脉及颈内静脉,猴缓慢复苏。于缺血前、后连续监测脑电生理活动,手术中持续监测中心体温、脉搏、呼吸、血压及尿量,术后每天行中枢神经系统功能检查,取脑及心肺等重要脏器行光镜检查。常温组用相同方法灌流37℃林格氏液。结果在8只恒河猴中,选择性深低温组5只猴术中、术后血压、脉搏变化相对稳定,断血流70min后意识恢复并长期生存,术后脑电生理活动恢复到术前水平,术后中枢神经系统功能检查正常,心肺、脑等重要器官组织观察正常;常温组3只猴在灌流60min后未恢复意识,灌流结束1d内死亡,心肺、脑等重要器官可见不同程度异常。结论严重脑缺血后行选择性深低温顺行脑灌注60min是安全可靠的,无严重心肺并发症发生,不会遗留有不可逆性脑缺血损害。
Objective To study the effects of selective deep hypothermic cistern cerebral perfusion on the major organs of the brain, heart and lungs after cerebral ischemia in monkey. Methods 8 adult healthy rhesus monkeys were randomly divided into two groups: selective deep hypothermia group (bilateral carotid artery occlusion after cryogenic perfusion, n = 5), normal temperature group (bilateral common carotid artery occlusion, n = 3). After bilateral clamping of the common carotid artery for 10 min at room temperature, the selective deep hypothermia group was infused with Ringer’s solution at 2 ° C through the right internal carotid artery and returned to the right internal jugular vein to reduce the cerebral temperature to 18 ° C. After maintaining for 60 min, Close the common carotid artery and internal jugular vein, the monkey slowly recover. EEG activity was monitored continuously before and after ischemia. Central body temperature, pulse, respiration, blood pressure and urine volume were continuously monitored during operation. Central nervous system function tests were performed daily after operation. Light microscopy an examination. The same method was used to perfuse 37 ℃ Ringer’s solution at room temperature. Results Among the 8 rhesus macaques, the blood pressure and pulse of 5 hypothermia group were relatively stable after septicemia. After 70 minutes of disconnection, the consciousness recovered and lived for a long time. The electrophysiological activity returned to preoperative Normal central nervous system function examination, heart and lung, brain and other important organs and tissues were normal observation; normal temperature group 3 monkeys did not recover after 60min perfusion perfusion flow within 1d death, cardiovascular, brain and other important organs can be seen varying degrees of abnormal . Conclusion Severe cerebral ischemia followed by selective deep hypothermia 60min after cerebral perfusion is safe and reliable, no serious cardiovascular complications, will not leave irreversible cerebral ischemia damage.