健康成年人瓦氏动作对软脑膜动脉搏动和蛛网膜下腔宽度的影响。
Effects of the Valsalva maneuver on pial artery pulsation and subarachnoid width in healthy adults.
机构信息
Institute of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Tuwima Str. 15, 80-210 Gdansk, Poland.
出版信息
Microvasc Res. 2011 Nov;82(3):369-73. doi: 10.1016/j.mvr.2011.08.003. Epub 2011 Aug 16.
AIM
The objective was to characterize the effects of Valsalva maneuver (VM) on the amplitude of cerebrovascular pulsation (CVP), and to explore the direct interactions between the cerebral vasculature and the cerebrospinal fluid compartment in VMIII.
METHODS
Twenty-nine healthy volunteers between the ages of 25 and 40 (29.3 ± SE 4.0) were studied. Changes in the amplitude of CVP (cc-TQ) and width of subarachnoid space (SAS; sas-TQ) were recorded with NIR-T/BSS sensor. Changes in arterial blood pressure (ABP) and heart rate were measured using Finapres. Cerebral blood flow velocity (CBFV) in the left middle cerebral artery was recorded with transcranial doppler.
RESULTS
sas-TQ remained unchanged, while cc-TQ increased in VMI (+40% vs. baseline). In VMIIa, sas-TQ increase (+3.4% vs. baseline) and deep decrease in cc-TQ (-81% vs. baseline) were observed. sas-TQ decrease started in VMIIb (-2.7% vs. baseline), with simultaneous slight increase in cc-TQ (-58% vs. baseline). In VMIII deep sas-TQ decrease (-6.2% vs. baseline) was associated with huge increase in cc-TQ (+110% vs. baseline; r=-0.56, p<0.01). During VMIV sas-TQ increased (-4.8% vs. baseline) while cc-TQ decreased (+38% vs. baseline). The drop of cc-TQ in VMIIa was significantly greater than corresponding changes in CBFV and ABP. Increase in cc-TQ in VMIII preceded CBFV and ABP changes in VMIV.
CONCLUSION
The VM evokes significant changes in the amplitude of CVP. Changes in small vessel pulsation precede changes in CBFV. There are direct interactions between cc-TQ and sas-TQ in VMIII. NIR-T/BSS allows for continuous, non-invasive monitoring of the amplitude of CVP and width of the SAS.
目的
本研究旨在描述瓦尔萨尔瓦动作（Valsalva maneuver，VM）对脑血管搏动幅度（Cerebrovascular Pulsation，CVP）的影响，并探讨 VMIII 中脑血流与脑脊液腔之间的直接相互作用。
方法
研究纳入 29 名年龄在 25 岁至 40 岁之间的健康志愿者（29.3±SE4.0）。使用近红外光谱-双谱指数（Near Infrared Spectroscopy-Transcranial Bilirubin Spectroscopy，NIR-T/BSS）传感器记录 CVP 幅度（cc-TQ）和蛛网膜下腔宽度（subarachnoid space，SAS；sas-TQ）的变化。使用 Finapres 测量动脉血压（arterial blood pressure，ABP）和心率的变化。使用经颅多普勒（Transcranial Doppler，TCD）记录左侧大脑中动脉的脑血流速度（Cerebral Blood Flow Velocity，CBFV）。
结果
在 VM I 中，sas-TQ 保持不变，而 cc-TQ 增加（40%vs. 基线）。在 VM IIa 中，sas-TQ 增加（3.4%vs. 基线），cc-TQ 深度下降（81%vs. 基线）。在 VM IIb 中，sas-TQ 开始下降（-2.7%vs. 基线），同时 cc-TQ 略有增加（-58%vs. 基线）。在 VM III 中，sas-TQ 深度下降（-6.2%vs. 基线）与 cc-TQ 大幅增加（110%vs. 基线；r=-0.56，p<0.01）相关。在 VM IV 中，sas-TQ 增加（-4.8%vs. 基线），而 cc-TQ 减少（38%vs. 基线）。在 VM IIa 中，cc-TQ 的下降明显大于 CBFV 和 ABP 的相应变化。在 VM III 中，cc-TQ 的增加先于 VM IV 中 CBFV 和 ABP 的变化。
结论
VM 引起 CVP 幅度的显著变化。小血管搏动的变化先于 CBFV 的变化。在 VM III 中，cc-TQ 和 sas-TQ 之间存在直接相互作用。NIR-T/BSS 允许连续、非侵入性监测 CVP 幅度和 SAS 宽度。
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