Cerebral blood flow and cerebral oxygen consumption during nitroprusside-induced hypotension to less than 50 mmHg.
Cerebral blood flow and cerebral oxygen consumption during nitroprusside-induced hypotension to less than 50 mmHg.
复制标题
硝普钠引起的低血压时脑血流量和脑耗氧量低于50 mmHg。
DOI：
10.1097/00000542-198902000-00013
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发表时间：
1987
期刊：
影响因子：
8.8
通讯作者：
B. Dixneuf
中科院分区：
文献类型：
--
作者：
M. Pinaud;R. Souron;J. Lelausque;M. Gazeau;Y. Lajat;B. Dixneuf
作者确定了脑动脉瘤开颅手术期间深度诱发低血压（即平均动脉血压低于 50 mmHg）对低血压期之前、期间和之后（之后 20 分钟和 40 分钟）脑血流量和脑氧代谢率的影响。该研究针对 9 名成年人（平均年龄 29.2 岁）进行，他们在手术时清醒且意识清醒，无周围神经功能缺损。该研究是在打开硬脑膜的情况下进行的，使用了桡动脉插管、7-Fr 热稀释流动导向肺动脉导管和颈内静脉导管。 133氙动脉内注射技术用于测定未手术半球的局部脑血流量（rCBF）。在低血压期间，rCBF 保持不变（从 22.8 +/- 4.1 ml.100 g-1.min-1 到 23.8 +/- 4.6 ml.100 g-1.min-1）（MAP 从 87.8 +/- 10.4 mmHg 到 40.0 +/- 4.4 mmHg；P 小于 0.001），尽管由于脑灌注压和脑血管阻力也降低到类似程度。没有观察到严重的脑代谢紊乱。诱发低血压后会出现一段时期的脑血管阻力下降和 rCBF 增加。停止硝普钠（SNP）20分钟后，rCBF从23.8 +/- 4.6 ml.100 g-1.min-1增加至30.0 +/- 5.8 ml.100 g-1.min-1（P小于0.001），且高血压没有反弹。这些修改在 20 分钟后消失。通过 SNP 将平均动脉血压降低至 40 mmHg 显然对大脑是安全的，但不能排除低灌注区域以及局部大脑和脑脊液乳酸酸中毒的可能性，特别是在回缩的半球。
The authors determined the effect of profound induced hypotension (i.e., mean arterial blood pressure less than 50 mmHg) during craniotomy for cerebral aneurysm on cerebral blood flow and cerebral metabolic rate for oxygen before, during, and after (20 min and 40 min after) the hypotensive period. The study was performed on nine adults (mean age, 29.2 yr) who were awake and conscious without peripheral neurologic deficits at the time of surgery. The study was conducted with the dura open with the use of a radial artery cannula, a 7-Fr thermodilution flow-directed pulmonary artery catheter, and an internal jugular vein catheter. The 133xenon intraarterial injection technique was used to determine regional cerebral blood flow (rCBF) in the nonoperated hemisphere. rCBF remained unchanged (from 22.8 +/- 4.1 ml.100 g-1.min-1 to 23.8 +/- 4.6 ml.100 g-1.min-1) during the hypotensive period (MAP from 87.8 +/- 10.4 mmHg to 40.0 +/- 4.4 mmHg; P less than 0.001) despite an increase in cardiac index since cerebral perfusion pressure and cerebrovascular resistance decreased to a similar degree. No gross cerebral metabolic disturbances were observed. A period of decreased cerebrovascular resistance and increased rCBF followed induced hypotension. rCBF increased from 23.8 +/- 4.6 ml.100 g-1.min-1 to 30.0 +/- 5.8 ml.100 g-1.min-1 (P less than 0.001) 20 min after sodium nitroprusside (SNP) was stopped without rebound hypertension. These modifications disappeared 20 min later. Reduction of mean arterial blood pressure to 40 mmHg by SNP was apparently safe for the brain, although the possibility of low perfused regions and local brain and cerebrospinal fluid lactoacidosis, particularly in the retracted hemisphere, cannot be excluded.