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Journal of Zhejiang University SCIENCE A 2004 Vol.5 No.10 P.1290-1297

http://doi.org/10.1631/jzus.2004.1290


Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat


Author(s):  LI Zhi-jun, YIN Xiao-mei, YE Jian

Affiliation(s):  Department of Cardiothoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China; more

Corresponding email(s):   zhijunli833@hotmail.com

Key Words:  PH management, Cerebral oxygenation, Deep hypothermia, Cardiopulmonary bypass


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LI Zhi-jun, YIN Xiao-mei, YE Jian. Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat[J]. Journal of Zhejiang University Science A, 2004, 5(10): 1290-1297.

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author="LI Zhi-jun, YIN Xiao-mei, YE Jian",
journal="Journal of Zhejiang University Science A",
volume="5",
number="10",
pages="1290-1297",
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publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.2004.1290"
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%T Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat
%A LI Zhi-jun
%A YIN Xiao-mei
%A YE Jian
%J Journal of Zhejiang University SCIENCE A
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%N 10
%P 1290-1297
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%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.2004.1290

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T1 - Effects of pH management during deep hypothermic bypass on cerebral oxygenation: alpha-stat versus pH-stat
A1 - LI Zhi-jun
A1 - YIN Xiao-mei
A1 - YE Jian
J0 - Journal of Zhejiang University Science A
VL - 5
IS - 10
SP - 1290
EP - 1297
%@ 1869-1951
Y1 - 2004
PB - Zhejiang University Press & Springer
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DOI - 10.1631/jzus.2004.1290


Abstract: 
Objective: There is a remarkable lack of scientific evidence to support the option to use alpha-stat or pH-stat management, as to which is more beneficial to brain protection during deep hypothermic CPB. This study examined cortical blood flow (CBF), cerebral oxygenation, and brain oxygen consumption in relation to deep hypothermic CPB with alpha-stat or pH-stat management. Methods: Twenty-two pigs were cooled with alpha-stat or pH-stat during CPB to 15 °C esophageal temperature. CBF and cerebral oxygenation were measured continuously with a laser flowmeter and near-infrared spectroscopy, respectively. Brain oxygen consumption was measured with standard laboratory techniques. Results: During CPB cooling, CBF was significantly decreased, about 52.2%±6.3% (P<0.01 vs 92.6%±6.5% of pH-stat) at 15 °C in alpha-stat, whereas there were no significant changes in CBF in pH-stat. While cooling down, brain oxygen extraction (OER) progressively decreased, about 9.5%±0.9% and 10.9%±1.5% at 15 °C in alpha-stat and pH-stat, respectively. At 31 °C the decreased value in pH-stat was lower than in alpha-stat (29.9%±2.7% vs 22.5%±1.9%; P<0.05). The ratio of CBF/OER were 2.0±0.3 in alpha-stat and pH-stat, respectively; it was kept in constant level in alpha-stat, and significantly increased by 19 °C to 15 °C in pH-stat (4.9±0.9 vs 2.3±0.4; P<0.01). In mild hypothermia, cerebral oxyhemoglobin and oxygen saturation in alpha-stat were greater than that in pH-stat (102.5%±1.4% vs 99.1%±0.7%; P<0.05). In deep hypothermia, brain oxygen saturation in pH-stat was greater than that in alpha-stat (99.2%±1.0% vs 93.8%±1.0%; P<0.01), and deoxyhemoglobin in pH-stat decreased more greatly than that in alpha-stat (28.7%±6.8% vs 54.1%±4.7%; P<0.05). Conclusions: In mild hypothermic CPB, brain tissue oxygen saturation was greater in alpha-stat than in pH-stat. However, cerebral oxygenation and brain tissue oxygen saturation were better in pH-stat than in alpha-stat during profound hypothermia. PH-stat strategy provided much more oxygen to brain tissue before deep hypothermic circulatory arrest.

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