norwood on the beating heart two cases with continuous cerebral and myocardial perfusion诺伍德在跳动的心脏和连续脑和心肌灌注两种情况.pdfVIP

/supplements/4/SB Meeting abstracts Neurological complications after cardiac surgery Abstracts of the 2nd International Symposium on the Pathophysiology of Cardiopulmonary Bypass, 3rd December 1999, Aachen, Germany Supported by the ‘Deutsche Forschungsgemeinschaft’ Crit Care 2000, 4(Suppl B) © Current Science Ltd Lectures Pathophysiology of the cerebral circulation during cardiac surgery Jacques Berré Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium Although mortality rate after cardiac surgery has been Pressure autoregulation refers to the ability of the brain to drastically reduced, neurological complications remain a maintain total and regional CBF nearly constant despite significant problem. Several etiologic factors have been large changes in systemic arterial blood pressure, inde- proposed, including previous unrecognized neurological pendently of flow–metabolism coupling [5]. Pressure abnormality, embolic events, hypoxic insult, low cardiac autoregulation is generally preserved during hypothermic output, systemic inflammatory response, and altered cere- cardiopulmonary bypass. Impaired autoregulation has bral blood flow (CBF) and metabolism. Cerebral ischemia been reported mainly in pH-stat conditions due to can occur when cerebral oxygen is insufficient to meet the increasing PaCO2. Interestingly, CBF and metabolism global or regional cerebral oxygen consumption. Cerebral seem to be unaffected during pulsatile flow as compared circulation is normally regulated by several