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The study of prevention of venous air embolism -Concerning with dural sinus pressure

预防静脉空气栓塞的研究——与硬脑膜窦压力有关

基本信息

批准号：
62480302
负责人：
SOBATA Eiji
金额：
$ 3.84万
依托单位：
Hirosaki University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1987
资助国家：
日本
起止时间：
1987 至 1988
项目状态：
已结题

项目摘要

When dural sinus pressure was studied in the clinical cases and animal experiments in order to prevent venous air embolism,it was shown that,not only gravity,but also anteflexion and rotation of the neck,various manipulation during operation,durg-or bleeding-induced hypotension,etc.,were influenced for its development.On the other hand, it was considered that retroflexion of the neck,PEEP,neck and abdominal compression,extraneous fluid administration and drug induced hypertension are useful for its prevention. Among them,induced hypertension and continuous neck compression were expected for clinical application,and cerebral circulation(rCBF by H2 clearance method, vertebral blood flow by square wave electromagnetic flowmetry),cerebral function (cortical EEG)and function of blood brain barrier (BBB)due to these were further evaluated by animal experiments. (1)induced hypertension:The various changes at the increase of 40% of mean blood pressure at 45゜upright position were studied comparing with those of 80% rCBF and VBF increased to 8% and 7% by 40%-induced hypertension, while the autoregulation were broken down by 80% In cEEG, slow wave recognized by elevation of the operating table was considerably impproved by 40%,while rather aggravate by 80%. BBB dysruption was not noted by 40%-induced hypertension,while noted remarkably by 80%. (2)Neck compression:The cuff for the blood pressure mesurment was rolled so as to adhere to the skin,and its internal pressure was adjusted to 15mmHg,and 30mmHg was employed for control.rCBF decreased to 22,3% by 15mmHg of intracuff pressure,and more decreased to 45% by 30mmHg. The aggravating tendency of cerebral function and function of BBB was noted by neck compression.These results suggest that approx. 40%-induced hypertension contribute to the prevention of air embolism, and no problem for the clinical application,while neck compression has many problem for the clinical application.

在临床病例和动物实验中研究硬脑膜窦压力以预防静脉空气栓塞时，发现不仅重力，而且颈部的前屈和旋转，术中的各种操作，药物或出血引起的低血压等，另一方面，认为颈后屈、PEEP、颈部和腹部压迫、外源性补液和药物性高血压对预防本病有一定作用。其中，诱导性高血压和持续颈部压迫有望在临床上应用，并通过动物实验进一步评价脑循环（H2清除法测定rCBF，方波电磁流量计测定椎动脉血流量）、脑功能（皮质EEG）和由此引起的血脑屏障（BBB）功能。（1）高血压：直立位45 °平均血压升高40%时，与高血压组80%时rCBF和VBF分别升高8%和7%，自动调节功能被破坏80%时比较，cEEG的变化，手术台抬高引起的慢波明显提高40%，而80%时慢波加重。40%的高血压患者未出现血脑屏障破裂，而80%的高血压患者出现血脑屏障破裂。（2）颈部压迫法：将血压测量袖带卷起，使其紧贴皮肤，调整袖带内压为15 mmHg，对照组为30 mmHg，袖带内压15 mmHg时rCBF下降22.3%，30 mmHg时rCBF下降45%。颈部压迫可使脑功能及血脑屏障功能有加重趋势。40%的诱导性高血压有助于预防空气栓塞的发生，临床应用无问题，而颈部压迫法的临床应用存在诸多问题。