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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
- 陆军军医大学学报 2022年44卷第17期 页码：1687-1693
- 作者机构：
400037 重庆，陆军军医大学(第三军医大学)第二附属医院麻醉科
- 作者简介：
[ 李洪，Email：lh78553@126.com LI Hong, E-mail: lh78553@126.com
- 基金信息：国家重点研发计划(2018YFC0117200)
DOI：10.16016/j.2097-0927.202205113
中图分类号： R331.37;R965;R972.4收稿：2022-05-19，
修回：2022-07-15，
纸质出版：2022-09-15
- 稿件说明：
移动端阅览
左都坤, 李阳, 彭滔滔, 等. 硝普钠控制性降压对猪脑局部血流和氧合的影响[J]. 陆军军医大学学报, 2022,44(17):1687-1693.
Dukun ZUO, Yang LI, Taotao PENG, et al. Effects of controlled hypotension induced by sodium nitroprusside on regional cerebral blood flow and oxygenation in pigs[J]. Journal of Army Medical University, 2022, 44(17): 1687-1693.
左都坤, 李阳, 彭滔滔, 等. 硝普钠控制性降压对猪脑局部血流和氧合的影响[J]. 陆军军医大学学报, 2022,44(17):1687-1693. DOI： 10.16016/j.2097-0927.202205113.
Dukun ZUO, Yang LI, Taotao PENG, et al. Effects of controlled hypotension induced by sodium nitroprusside on regional cerebral blood flow and oxygenation in pigs[J]. Journal of Army Medical University, 2022, 44(17): 1687-1693. DOI： 10.16016/j.2097-0927.202205113.
摘要
目的
2
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
2
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 pr
essure
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
2
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(
R
2
=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
2
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。
Abstract
Objective
2
To investigate the effects of controlled hypotension induced by sodium nitroprusside on regional cerebral blood flow and oxygenation in pigs.
Methods
2
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 (O2C)
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
2
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
2
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
Keywords
references
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