Noninvasive autoregulation monitoring in a swine model of pediatric cardiac arrest.
Noninvasive autoregulation monitoring in a swine model of pediatric cardiac arrest.
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DOI：
10.1213/ane.0b013e31824762d5
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发表时间：
2012-04
影响因子：
5.7
通讯作者：
Shaffner DH
中科院分区：
文献类型：
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作者：
Lee JK;Yang ZJ;Wang B;Larson AC;Jamrogowicz JL;Kulikowicz E;Kibler KK;Mytar JO;Carter EL;Burman HT;Brady KM;Smielewski P;Czosnyka M;Koehler RC;Shaffner DH
复苏后的脑血管自动调节尚未在儿童心脏骤停的实验模型中得到充分研究。此外，开发使用近红外光谱（NIRS）监测自动调节的无创方法将在临床上有助于指导小儿心脏骤停后的神经保护血流动力学管理。我们测试了以下假设：在心脏骤停后恢复 1 至 2 天内，自动调节下限 (LLA) 将转变为较高的动脉血压，并且在小儿心脏骤停的猪模型中，LLA 将通过 NIRS 衍生的自动调节指数检测到。我们还测试了心脏骤停后高血压的自身调节会受到损害的假设。 LLA 数据取自经历缺氧窒息性心脏骤停并恢复 1 天 (n=8) 或 2 天 (n=8) 或接受假手术并恢复 2 天 (n=8) 的新生仔猪。在另一组接受缺氧窒息心脏骤停（n = 5）或假手术（n = 5）且恢复2天的仔猪中检查了高血压的自动调节。恢复期后，将仔猪重新麻醉，并通过标准激光多普勒血流计和源自 NIRS 的自动调节指数（脑血氧饱和度 [COx] 和血红蛋白体积 [HVx] 指数）监测自动调节。 LLA 是通过使下腔静脉中的球囊导管膨胀来降低血压来确定的。通过主动脉球囊导管的充气来评估高血压期间的自动调节。假手术仔猪和被捕后 1 或 2 天恢复的仔猪之间的 LLA 相似。 NIRS 衍生指数准确地检测到激光多普勒血流计测定的 LLA。脑血氧饱和度指数的受试者工作特征曲线下面积在逮捕后第 1 天为 0.91，第 2 天为 0.92。血红蛋白体积指数的曲线下面积在各个时间点为0.92和0.89。在诱发高血压期间，静态自动调节率（定义为脑血管阻力变化百分比除以脑灌注压变化百分比）在停顿后仔猪和假手术仔猪之间没有差异。从逮捕中恢复 2 天后，仔猪表现出神经行为缺陷和组织学神经元损伤。在已证实脑损伤的儿童缺氧窒息性心脏骤停的猪模型中，复苏后 1 天和 2 天的 LLA 没有差异。与这些时间点的激光多普勒血流测量相比，NIRS 衍生指数准确地检测到了 LLA。高血压期间自动调节仍然发挥作用。
Cerebrovascular autoregulation after resuscitation has not been well studied in an experimental model of pediatric cardiac arrest. Furthermore, developing noninvasive methods of monitoring autoregulation using near-infrared spectroscopy (NIRS) would be clinically useful in guiding neuroprotective hemodynamic management after pediatric cardiac arrest. We tested the hypotheses that the lower limit of autoregulation (LLA) would shift to a higher arterial blood pressure between 1 and 2 days of recovery after cardiac arrest and that the LLA would be detected by NIRS-derived indices of autoregulation in a swine model of pediatric cardiac arrest. We also tested the hypothesis that autoregulation with hypertension would be impaired after cardiac arrest. Data on LLA were obtained from neonatal piglets that had undergone hypoxic-asphyxic cardiac arrest and recovery for 1 day (n=8) or 2 days (n=8), or that had undergone sham surgery with 2 days of recovery (n=8). Autoregulation with hypertension was examined in a separate cohort of piglets that underwent hypoxic-asphyxic cardiac arrest (n=5) or sham surgery (n=5) with 2 days of recovery. After the recovery period, piglets were reanesthetized, and autoregulation was monitored by standard laser-Doppler flowmetry and autoregulation indices derived from NIRS (the cerebral oximetry [COx] and hemoglobin volume [HVx] indices). The LLA was determined by decreasing blood pressure through inflation of a balloon catheter in the inferior vena cava. Autoregulation during hypertension was evaluated by inflation of an aortic balloon catheter. The LLAs were similar between sham-operated piglets and piglets that recovered for 1 or 2 days after arrest. The NIRS-derived indices accurately detected the LLA determined by laser-Doppler flowmetry. The area under the curve of the receiver operator characteristic curve for cerebral oximetry index was 0.91 at 1 day and 0.92 at 2 days after arrest. The area under the curve for hemoglobin volume index was 0.92 and 0.89 at the respective time points. During induced hypertension, the static rate of autoregulation, defined as the percent change in cerebrovascular resistance divided by the percent change in cerebral perfusion pressure, was not different between postarrest and sham-operated piglets. At 2 days recovery from arrest, piglets exhibited neurobehavioral deficits and histologic neuronal injury. In a swine model of pediatric hypoxic-asphyxic cardiac arrest with confirmed brain damage, the LLA did not differ 1 and 2 days after resuscitation. The NIRS-derived indices accurately detected the LLA compared to laser-Doppler flow measurements at those time points. Autoregulation remained functional during hypertension.