Phenylephrine Increases Cerebral Blood Flow during Low‐flow Hypothermic Cardiopulmonary Bypass in Baboons
Phenylephrine Increases Cerebral Blood Flow during Low‐flow Hypothermic Cardiopulmonary Bypass in Baboons
复制标题
去氧肾上腺素增加狒狒低流量低温心肺搭桥期间的脑血流量
作者：
A. Schwartz;O. Minanov;Gilbert J. Stone;D. Adams;A. A. Sandhu;M.E. Pearson;P. Kwiatkowski;W. Young;R. Michler
背景：尽管低流量体外循环(CPB)已成为儿童复杂心脏病变外科修复的首选方法，但与低流量相关的相对低血压和脑血流量(CBF)减少可能导致术后神经损伤的发生。因此，可以确定在低流量CPB期间使用苯肾上腺素升高动脉血压是否会增加CBF。方法7只狒狒在芬太尼、咪达唑仑、异氟醚麻醉下开始体外循环。以2.5的泵流量冷却动物直到食道温度降至2 0℃，体外循环流量降至0.5 L*符号*min-1*符号*m-2(低流量)。在低流量CPB期间，动脉二氧化碳分压(PCO2)和血压随机变化为三种情况：(1)二氧化碳分压30~39毫米汞柱(未经温度校正)，控制血压；(2)二氧化碳分压50~60毫米汞柱，控制血压；(3)二氧化碳分压30~39毫米汞柱，用苯肾上腺素使血压升高两倍。此后，将体外循环流量增加到2.5%L*符号*分钟~(-1)*符号*m~(-2)，并将狒狒复温至常温。在CPB前和CPB期间，用动脉内冲洗133氙气的方法测量脑血流量。结果低流量体外循环期间应用苯肾上腺素使平均血压由23+/-3升至46+/-3毫米汞柱，脑血流量由14+/-3升至31+/-9毫升*符号*分钟-1*符号*100g-1，P<0.05。低流量搭桥术中动脉血二氧化碳分压的变化对脑血流量没有影响。结论低流量体外循环下CBF明显低于转流前和全流量转流前，但在低流量转流期间以双动脉压给药的苯肾上腺素可使CBF成比例增加。
Background Although low‐flow cardiopulmonary bypass (CPB) has become a preferred technique for the surgical repair of complex cardiac lesions in children, the relative hypotension and decrease in cerebral blood flow (CBF) associated with low flow may contribute to the occurrence of postoperative neurologic injury. Therefore, it was determined whether phenylephrine administered to increase arterial blood pressure during low‐flow CPB increases CBF. Methods Cardiopulmonary bypass was initiated in seven baboons during fentanyl, midazolam, and isoflurane anesthesia. Animals were cooled at a pump flow rate of 2.5 l *symbol* min‐1 *symbol* m‐2 until esophageal temperature decreased to 20 degrees C. Cardiopulmonary bypass flow was then reduced to 0.5 l *symbol* min‐1 *symbol* m‐2 (low flow). During low‐flow CPB, arterial partial pressure of carbon dioxide (PCO2) and blood pressure were varied in random sequence to three conditions: (1) PCO2 30–39 mmHg (uncorrected for temperature), control blood pressure; (2) PCO2 50–60 mmHg, control blood pressure; and (3) PCO2 30–39 mmHg, blood pressure raised to twice control by phenylephrine infusion. Thereafter, CPB flow was increased to 2.5 l *symbol* min‐1 *symbol* m‐2, and baboons were rewarmed to normal temperature. Cerebral blood flow was measured by washout of intraarterial133 Xenon before and during CPB. Results Phenylephrine administered to increase mean blood pressure from 23+/‐3 to 46+/‐3 mmHg during low‐flow CPB increased CBF from 14+/‐3 to 31+/‐9 ml *symbol* min‐1 *symbol* 100 g‐1, P < 0.05. Changes in arterial PCO2 alone during low flow bypass produced no changes in CBF. Conclusion Although low‐flow CPB resulted in a marked decrease in CBF compared with prebypass and full‐flow bypass, phenylephrine administered to double arterial pressure during low‐flow bypass produced a proportional increase in CBF.
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DOI：
--
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DOI：
--
发表时间：
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影响因子：
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