The effects of hyperventilation on cerebral blood flow in the rat with an open and closed carotid-jugular fistula.
The effects of hyperventilation on cerebral blood flow in the rat with an open and closed carotid-jugular fistula.
复制标题
过度换气对开放性和闭合性颈动脉-颈静脉瘘大鼠脑血流的影响。
DOI：
10.1097/00006123-198910000-00015
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发表时间：
1989
期刊：
影响因子：
4.8
通讯作者：
SundtJr,TM
中科院分区：
文献类型：
--
作者：
Morgan,MK;Anderson,RE;SundtJr,TM
在动静脉畸形(Avms)切除后肿胀和出血的发病机制中，动静脉分流术消融时脑血流动力学的扰动被认为是重要的。先前对大鼠颈动脉-颈静脉瘘模型进行了研究，发现该模型部分模拟了大型脑动静脉瘘的非出血性病理生理学。利用该模型，用[14 C]安替比林放射自显影技术测量了14个脑区的脑血流量，观察了低碳酸血症对开放和闭合性瘘管的脑循环的影响。对照组动脉血二氧化碳分压(PaCO2)为2 8±2 mm Hg时，局部脑血流量(RCBF)为5 3~m l/10 0 g/min；在研究前12周发生开放颈静脉瘘的动物中，在可比的PaCO2水平下，这些rCBF值的中位数分别为15至39ml/100g/min和50至68ml/100g/min(在所研究的14个区域中，低碳酸血症组开放瘘的第25百分位数为15ml/100g/min)。相比之下，闭合性瘘管组的rCBF中位数在低二氧化碳动物为73~100ml/100g/min，在正常二氧化碳动物为118~187ml/100g/min。这些结果表明，在这种脑动静脉瘘模型中，保留了二氧化碳的反应性；在存在颈动脉-颈静脉瘘的情况下，低灌流；在瘘闭塞时，充血；以及在过度换气的情况下，可能诱发脑缺血。这些数据告诫不要在脑动静脉畸形患者的手术中使用过度换气。
Perturbations in cerebral hemodynamics at the time of ablation of an arteriovenous shunt have been regarded as important in the pathogenesis of swelling and hemorrhage complicating resection of arteriovenous malformations (AVMs). A carotid-jugular fistula model in the rat had previously been investigated and found to simulate in part the nonhemorrhagic pathophysiology of a large cerebral arteriovenous fistula. Utilizing this model and measuring cerebral blood flow in 14 regions with a [14 C] iodoantipyrine autoradiographic technique, the effects of hypocapnea on the cerebral circulation in opened and closed fistulas were investigated. Regional cerebral blood flow (rCBF) in control animals ranged from a median of 53 to 64 ml/100 g/min at a partial arterial carbon dioxide pressure (PaCO 2) of 28±2 mm Hg and 85 to 112 ml/100 g/min at a PaCO 2 of 40±5 mm Hg. In animals with an open carotid-jugular fistula created 12 weeks before the study, these median rCBF values at comparable PaCO 2 levels ranged, respectively, from 15 to 39 ml/100 g/min and 50 to 68 ml/100 g/min (the 25th percentile for the open fistula in the hypocapneic group was 15 ml/100 g/min in 5 of the 14 regions studied). In contrast, median rCBF in the closed fistula group ranged from 73 to 100 ml/100 g/min in hypocapneic animals and from 118 to 187 ml/100 g/min in normocapneic animals. These results demonstrate the preservation of CO 2 reactivity; hypoperfusion in the presence of a carotid-jugular fistula, hyperemia on fistula occlusion, and the potential to induce cerebral ischemia with hyperventilation in this model of a cerebral arteriovenous fistula. These data caution against the use of hyperventilation during surgery in patients with cerebral arteriovenous malformations.(Neurosurgery 25: 606-612, 1989)