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CEREBRAL PERFUSION DURING CARDIOPULMONARY BYPASS: ANALYSIS BY TRANSCRANIAL DOPPLER TECHNIQUE.

Research Project

Project/Area Number 02454333
Research Category

Grant-in-Aid for General Scientific Research (B)

Allocation TypeSingle-year Grants
Research Field Thoracic surgery
Research InstitutionSt. Marianna University School of Medicine

Principal Investigator

KAWADA Tadanori  ST.MARIANNA UNIVERSITY SCHOOL OF MEDICINE ASSOCIATE PROFESSOR, 医学部, 助教授 (80081735)

Co-Investigator(Kenkyū-buntansha) YAMATE Noboru  ST.MARIANNA UNIVERSITY SCHOOL OF MEDICINE PROFESSOR, 医学部, 教授 (10089716)
OKADA Tadahiko  ST.MARIANNA UNIVERSITY SCHOOL OF MEDICINE Assistant Professor, 医学部, 講師 (60097342)
KAMATA Satoshi  ST.MARIANNA UNIVERSITY SCHOOL OF MEDICINE Research Associate, 医学部, 助手 (70224649)
Project Period (FY) 1990 – 1992
Project Status Completed (Fiscal Year 1992)
Budget Amount *help
¥4,400,000 (Direct Cost: ¥4,400,000)
Fiscal Year 1992: ¥400,000 (Direct Cost: ¥400,000)
Fiscal Year 1991: ¥400,000 (Direct Cost: ¥400,000)
Fiscal Year 1990: ¥3,600,000 (Direct Cost: ¥3,600,000)
KeywordsTranscranial Doppler technique / Cardiopulmonary bypass / Hypothermia / alpha-stat management / pH-stat management / 中大脳動脈血流速度 / pH-stat管理 / 経頭蓋的超音波ドップラ-法 / 低体温体外循環 / 脳血流速度 / PaCO_2 / αーstat管理 / pHーstat管理 / 経頭蘆骨的ドップラ-脳血流測定 / pCO_2 / alpahーstat / pHーstat
Research Abstract

The middle cerebral artery flow velocity (MCA-V) was continuously measured by the transcranial Doppler (TCD) technique in consecutive 50 patients who underwent open heart surgery with the aid of hypothermic cardiopulmonary bypass(CPB). This study was intended to evaluate the effects of changes in blood gas management, perfusion pressure and flow rate on MCA-V. MCA-V measurement was performed by the use of TCD sonography (EME, TC2-64).
The first 10 patients were managed by alpha-stat management and in the other 30 cases, CPB was started by alpha-stat management followed by pH-stat conversion for 15 minutes by adding CO_2 gas into the oxygenator gas line. In additional 10 cases, perfusion flow rate was manipulated from 2.4 L/m^2/min to 1.5 L/m^2/min at the body temperature below 30゚C.
In the case of alpha-stat management during CPB, MCA-V reduced to 47.8 * 19.8% of pre-CPB value and increased to 112.0 * 56.2% after weaning from CPB. Reduced MCA-V during alpha-stat management significantly … More increased immediately after pH-stat conversion. The change in MCA-V (DELTAMCA-V) did not correlate with the change in mean arterial pressure (DELTAMAP) in alpha-stat management, however, correlated in pH-stat management. DELTAMCA-V/DELTAPaCO_2 (PaCO_2-R) correlated with the change in body temperature at least of 20゚C or more. MCA-V showed no significant reduction in response to the reduction of the flow rate from 2.4 to 1.5 L/m^2/min in alpha-stat management. On the other hand, MCA-V reduced correlating with the flow rate reduction in pH-stat management. But, MCA-V levels in pH-stat management were always kept higher during hypothermia at least above 20゚C than those in alpha-stat management.
In conclusions;
1) Cerebral autoregulation is maintained in the case of alpha-stat management during moderate hypothermic CPB, however, it is abolished by pH-stat management.
2) Sensitivity of cerebral resistance vessels to PaCO_2 changes decreased with a drop of body temperature.
3) Higher cerebral blood flow is maintained in pH-stat management in hypothermin, however, further study is necessary to confirm it being beneficial or not for the protection of the brain during CPB. Less

Report

(4 results)
  • 1992 Annual Research Report   Final Research Report Summary
  • 1991 Annual Research Report
  • 1990 Annual Research Report
  • Research Products

    (3 results)

All Other

All Publications (3 results)

  • [Publications] Johnsson,P., Masseter,K., Ryding,E., et al: "Cerebral vasoreactivity to carbon dioxide during cardiopulmonary perfusion at normothermia and hypothermia." Ann Thorac Surg. 48. 769-75 (1989)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1992 Final Research Report Summary
  • [Publications] Aaslid,R., Markwalder,T.M., Nornes,H.: "Noninvesive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries." J Neurosurg. 57. 769-74 (1982)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1992 Final Research Report Summary
  • [Publications] 遠藤 慎一: "経頭的超音波ドップラ-法による体外循環中の脳循環動態に関する検討" 聖マリアンナ医科大学雑誌. 19. 582-591 (1991)

    • Related Report
      1991 Annual Research Report

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Published: 1990-04-01   Modified: 2016-04-21  

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