硝普钠控制性降压对猪脑局部血流和氧合的影响  

Effects of controlled hypotension induced by sodium nitroprusside on regional cerebral blood flow and oxygenation in pigs

作　　者：左都坤 李阳 彭滔滔 刘华为 杨贵英 段振馨 李洪 ZUO Dukun;LI Yang;PENG Taotao;LIU Huawei;YANG Guiying;DUAN Zhenxin;LI Hong(Department of Anesthesiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院麻醉科,重庆400037

出　　处：《陆军军医大学学报》2022年第17期1687-1693,共7页Journal of Army Medical University

基　　金：国家重点研发计划(2018YFC0117200)。

摘　　要：目的探讨硝普钠控制性降压对猪脑局部血流和氧合的影响。方法健康雌性长白猪6头,4~6月龄,体重22~25 kg。在七氟醚麻醉下使用硝普钠进行控制性降压(分别较平均动脉压基础值降低20%、30%、50%,分别对应轻、中、重度降压),并使用氧立见(oxygen to see,O2C)直接测量猪脑前额部局部脑血流(regional cerebral blood flow,rCBF)以及局部脑组织氧饱和度(regional cerebral oxygen saturation,rSO_(2))。记录不同平均动脉压(mean arterial pressure,MAP)下的rCBF、rSO_(2)、局部血红蛋白(regional cerebral haemoglobin,rHb)、心率(heart rate,HR)、外周血氧饱和度(peripheral oxygen saturation,SpO_(2))以及脑缺氧事件的发生情况。结果在整个降压过程中rCBF与MAP(r=0.793)和rSO_(2)(r=0.843)均显著相关。rSO_(2)与MAP、rHb和rCBF呈线性相关(R2=0.853,P<0.05),且与rSO_(2)的线性相关程度依次为rHb>MAP>rCBF。轻度降压时,rCBF和rSO_(2)分别较基线值增加约7.4%(P<0.05)和2.5%(P<0.05),以rCBF增加更显著;而中度降压时,rCBF较基线值下降0.9%(P>0.05),而rSO_(2)较基线值下降约5.8%(P<0.05);重度降压时,rCBF和rSO_(2)较基线值分别下降约7.6%(P<0.05)和12.1%(P<0.05)。轻至重度降压时均未出现脑缺氧事件。停药后5 min至15 min,rCBF与rSO_(2)均较基线值增加,分别增加8.4%(P<0.05)和3.7%(P<0.05)。结论使用硝普钠行控制性降压对维持大脑灌注、脑氧合有利,但轻度降压可增加脑血流,对颅内压已增高患者不利。Objective To investigate the effects of controlled hypotension induced by sodium nitroprusside on regional cerebral blood flow and oxygenation in pigs.Methods Six healthy female Landrace pigs(aged 4~6 months,weighing 22~25 kg)were included in this study.Sodium nitroprusside was used for controlled hypotension under sevoflurane anesthesia(20%,30%and 50%lower than the baseline of mean arterial pressure or mean arterial pressure(MAP),corresponding to mild,moderate and severe hypotension,respectively).Oxygen to see(O2 C),a monitoring instrument,was used to measure regional cerebral blood flow(rCBF)and regional cerebral oxygen saturation(rSO_(2)).rCBF,rSO_(2),regional cerebral haemoglobin(rHb),heart rate(HR),peripheral oxygen saturation(SpO_(2))and incidence of cerebral hypoxia events were recorded under different MAP.Results rCBF was significantly correlated with MAP(r=0.793)and also obviously correlated with rSO_(2)(r=0.843)in the whole hypotension process.rSO_(2)had a linear correlation with rHb,MAP and rCBF(R~2=0.853,P<0.05),respectively.And the order of their linear correlation with rSO_(2)is rHb>MAP>rCBF.During mild hypotension,rCBF and rSO_(2)were increased by 7.4%(P<0.05)and 2.5%(P<0.05),respectively compared with the baseline,and the increase of rCBF was more remarkable.During moderate hypotension,compared with the baseline,rCBF was decreased by 0.9%(P>0.05),while rSO_(2)was decreased by 5.8%(P<0.05).During severe hypotension,rCBF and rSO_(2)were decreased by 7.6%(P<0.05)and 12.1%(P<0.05)respectively,and there was no cerebral hypoxia event during mild to severe hypotension.From 5 to 15 min after drug withdrawal,both rCBF and rSO_(2)were increased by 8.4%and 3.7%,respectively when compared with the baseline(both P<0.05).Conclusion Controlled hypotension with sodium nitroprusside is beneficial to maintain cerebral perfusion and cerebral oxygenation,but mild hypotension can cause an increase in cerebral blood flow,which is disadvantageous to patients with increased intracranial pressure.

关 键 词：麻醉 控制性降压 硝普钠 脑血流量 脑氧饱和度 

分 类 号：R331.37[医药卫生—人体生理学] R965[医药卫生—基础医学] R972.4