弓部大動脈再建におけるOpen Distal Anastomosis 時の腎虚血許容温度に関する実験的研究
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The reconstruction of aortic arch aneurysms has become increasingly feasible with continuing developments in surgical techniques and support methods. Recently the technique of open distal anastomisis (OD) has been used concomitantly with selective cerebral per fusion and has simplified the operation considerably, as exposure of the aortic aneurysm is obtained through a median sternotomy and a left thoracotomy is no longer required. However, the satety temperature and interval of OD for the preservation of organic function in the lower body has not yet been established. An experimental study was designed to clarify the safety margins of OD for prservation of renal function. Twenty-nine -adult mongrel dogs were subjected to OD and low flow per fusion for 60 minutes under extracorporeal circulation (ECC). They were divided into four groups. In Group I (n=7), OD was performed with the rectal temperature maintained at 20℃. In Group II (n=8), the rectal temperature was 25℃. In Group III (n=7), it was 30℃. In Group IV (n=7), it was 37℃. In addi- tion, twelve adult mongrel dogs were used as controls. In Group N (n=6), only nephrectomy was performed after anesthesia; in Group E (n=6), ECC was performed without OD at 37℃ for the same period as in the other groups. The kidneys were removed from all subjects 120 minutes after OD to evaluate the state of their adenine nucleotide metabolism. The following conclusions were obtained from this study. (1) ATP content and energy charge (EC) in Group III and Group IV were significantly lower than in the other groups. (2) Water con- tents of the renal cells in Group III and Group IV were significantly higher than in the other groups. (3) Histological studies showed necrotic changes of epithelial cells of the tubules in Group III and Group IV. The other groups showed ischemic changes such as edema of epithelial cells of tubules but no necrotic changes. Therefore, the safety temperature range for OD of 60 minutes duration is 20-25ｰ℃.
- 1993-02-01
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