Impact of a beta-blocker and/or acute hemodilution on cerebral oxygenation during apneic hypoxia
Impact of a beta-blocker and/or acute hemodilution on cerebral oxygenation during apneic hypoxia
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β-受体阻滞剂和/或急性血液稀释对呼吸暂停缺氧期间脑氧合的影响
DOI：
10.1111/aas.12637
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Sato S
中科院分区：
文献类型：
--
作者：
Kurita T;Morita K;Sato S
背景β受体阻滞剂通过降低脑氧合降低急性血液稀释的耐受性，并可能导致卒中的发生。我们假设β受体阻滞剂也增加了脑缺氧的风险时，呼吸暂停hypoxiaoccurs.MethodsAfter诱导异氟烷，14只猪（平均值± SD =25.3 ± 0.8 kg）进行了研究，使用200 μg/kg/min的兰地洛尔或生理盐水（对照组）在三个连续的阶段：前，期间，和后兰地洛尔（生理盐水）输注。在每个阶段，在100%氧的机械通气5 min后，诱导呼吸暂停，直到氧饱和度< 70%的时间。测定血流动力学和血气指标，采用近红外光谱法记录脑组织氧合指数（TOI）（呼吸暂停实验）。结果兰地洛尔使呼吸暂停后1 min和SpO 2 < 70%时的TOI分别较基线值下降3.3%和7.0%，与对照组比较，差异有统计学意义（P <0.05）。血液稀释时分别为13.1%和20.3%。兰地洛尔使TOI与动脉血氧饱和度（SaO 2）或动脉血氧分压（PaO 2）之间的关系向左移动;并在相似的动脉血氧合下降低TOI。这种现象是显着的血液diluation.ConclusionsLandiolol减少脑组织氧合在窒息缺氧。当发生呼吸暂停缺氧时，β受体阻滞剂会增加脑缺氧的风险，尤其是在急性血液稀释期间。
Backgroundβ‐blockers reduce the tolerance for acute hemodilution by decreasing cerebral oxygenation and may contribute to the incidence of stroke. We hypothesized that β‐blockers also increase the risk for cerebral hypoxia when apneic hypoxia occurs.MethodsAfter induction of isoflurane, 14 swine (mean ± SD =25.3 ± 0.8 kg) were studied using 200 μg/kg/min of landiolol or saline (control group) in three sequential stages: before, during, and after landiolol (saline) infusion. In each stage, after 5 min of mechanical ventilation with 100% oxygen, apnea was induced until the time to < 70% oxygen saturation. Hemodynamic and blood gas variables were measured, and the cerebral tissue oxygenation index (TOI) was recorded by near infrared spectroscopy (apnea experiment). After these steps, hemodilution was induced by hemorrhage of 600 ml and infusion of the same volume of hydroxyethylstarch, and the apnea experiments were then conducted before, during, and after landiolol (saline) infusion similarly to before hemodilution.ResultsLandiolol decreased TOI at 1 min after apnea and at SpO2< 70% by 3.3% and 7.0% from each corresponding value at baseline, and by 13.1% and 20.3% during hemodilution. Landiolol shifted the relationship between TOI and arterial hemoglobin oxygen saturation (SaO2) or arterial partial pressure of oxygen (PaO2) to the left; and reduced TOI at similar arterial blood oxygenation. This phenomenon was marked during hemodilution.ConclusionsLandiolol reduces cerebral tissue oxygenation during apneic hypoxia. β‐blockers increase the risk for cerebral hypoxia when apneic hypoxia occurs, especially during acute hemodilution.