Comparison Of Efficacy Between Selective Antegrade Cerebral Perfusion And Deep Hypothermic Circulatory Arrest And Effects Of Ulinastatin On Brain Injury During Pediatric Aortic Arch Surgery

PART ⅠCOMPARATIVE STUDY OF SELECTIVE ANTEGRADECEREBRAL PERFUSION AND DEEP HYPOTHERMICCIRCULATORY ARREST DURING PEDIATRIC AORTICARCH SURGERYObjective To compare the efficacy between selective antegradecerebral perfusion (SACP) and deep hypothermic circulatory arrest (DHCA)used in pediatric aortic arch surgery.Methods Fifty-three cases undergoing repair of coarctation of aorta orinterrupted aortic arch complicated with cardiac monstrosity from January2008to July2011in our hospital were retrospectively reviewed.Intraoperative cardiopulmonary bypass conditions such as cardiopulmonarybypass time, aortic clamping time, DHCA time or SACP time, the lowestnasopharyngeal and rectal temperatures, and postoperative outcomes such as postoperative intubation time, length of ICU stay, thorax output duringpostoperative24hours, and occurrence of hospital mortality andpostoperative complications were recorded. These53cases were dividedinto two groups according to the method of cerebral protection: DHCAgroup (n=23) and SACP group (n=30). Perioperative variables betweenthe two groups were compared.Results The lowest nasopharyngeal and rectal temperature weresignificantly higher, postoperative intubation time and length of ICU staywere shorter, and thorax output during postoperative24hours was less inSACP group than in DHCA group (P<0.05). There was no significantdifference between two groups in terms of hospital mortality, occurrence ofpostoperative neurological complication, acute renal failure and low cardiacoutput syndrome (P>0.05).Conclusions Cerebral protective effect of SACP and DHCA inpediatric aortic arch surgery is comparable. SACP seems to be beneficial forpulmonary recovery, length of ICU stay and postoperative blooding. PART ⅡEFFECTS OF ULINASTATIN ON BRAIN INJURY INCHILDREN UNDERGOING AORTIC ARCH SURGERYUNDER CARDIOPULMONARY BYPASSObjective To investigate the effects of unilastatin on brain injury inchildren undergoing aortic arch surgery under cardiopulmonary bypass(CPB)．Methods Twenty ASA Ⅲ or Ⅳ children of both sexes aged1-24months weighing3-12kg undergoing repair of coarctation of aorta orinterrupted aortic arch complicated with cardiac monstrosity under CPBand selective antegrade cerebral perfusion were randomly divided into twogroups (n=10each): ulinastatin group (group U) and control group (groupC)．In group U ulinastatin20000U/kg that was diluted to10000U/ml bynormal saline was given in3parts (1/3was infused via internal jugularvein after induction of anesthesia;1/3at the beginning of CPB and1/3at5min before aortic unclamping)．In group C normal saline was given insteadof ulinastatin at the same time point．Blood samples were taken from radialartery after induction of anesthesia (T1),10min after aortic clamping (T2),10min after aortic unclamping (T3), at the end of CPB (T4), and6and24hours after CPB (T5, T6) for determination of plasma S100B protein(S100B) and neuron specific enolase (NSE) by enzyme-linked immunosorbent assay (ELISA).Results There was no significant difference between the two groups inplasma levels of S100B and NSE at T1(P＞0.05). Plasma S100B and NSElevels were significantly increased at T2~5as compared to the baselinevalues at T1in both groups (P＜0.05). There was no significant differencein plasma levels of S100B and NSE between T6and T1in both groups (P＞0.05). Plasma S100B and NSE levels were significantly lower at T2~5ingroup U than in group C (P＜0.05).Conclusion Ulinastatin can attenuate brain injury in childrenundergoing aortic arch surgery under cardiopulmonary bypass.