Department of Anesthesiology, New York University Langone Medical Center, 550 First Avenue, Rusk 605, New York, NY 10016, USA.
Anesth Analg. 2012 May;114(5):1034-41. doi: 10.1213/ANE.0b013e31824b2b05. Epub 2012 Feb 24.
Acute hypotension may be implicated in cognitive dysfunction. L-type calcium channel blockers in the setting of hypoxia are protective of learning and memory. We tested the hypothesis that hypotension induced by nimodipine (NIMO) and nicardipine (NICA) would be protective of long- and short-term memory compared to hypotension induced by nitroglycerin (NTG).
Forty Swiss-Webster mice (30 to 35 g, 6 to 8 weeks) were randomized into 4 groups for i.p. injection immediately after passive avoidance (PA) learning on day 0: (1) NTG (30 mg/kg); (2) NICA (40 mg/kg); (3) NIMO (40 mg/kg); and (4) saline. PA training latencies (seconds) were recorded for entry from a suspended platform into a Plexiglas tube where a shock (0.3 mA; 2-second duration) was automatically delivered. On day 2 latencies were recorded during a testing trial during which no shock was delivered. Latencies >900 seconds were assigned this value. Lower testing latency is indicative of an impairment of long-term associative memory. Forty-nine additional mice were randomized into similar groups for object recognition testing (ORT) and given i.p. injections on day 0. ORT measures short-term memory by exploiting the tendency of mice to prefer novel objects where a familiar object is present. On day 5 during training, 2 identical objects were placed in a circular arena and mice explored both for 15 minutes. A testing trial was conducted 1 hour later for 3 minutes after a novel object replaced a familiar one. Mice with intact memory spend about 65% of the time exploring the novel object. Mice with impaired memory devote equal time to each object. Recognition index (RI) is defined as the ratio of time spent exploring the novel object to time spent exploring both objects was the measure of memory. Mean arterial blood pressure (MAP), cerebral bloodflow, and body and brain oxygenation (PO(2)) studies were done in separate groups of mice to determine the dosages for matched degrees of hypotension and the physiological profile of each treatment.
The median PA latencies for the different conditions were as follows: NTG (219.5 ± 93.5 second semi-interquartile range [SIQR]), NICA (372.5 ± 75.5 second SIQR), NIMO (540 ± 200 second SIQR) and saline (804 ± 257.5 second SIQR). Rank methods were used to analyze the PA latencies for significant differences. NTG latency was significantly shorter than NIMO latency (P = 0.012) and saline latency (P = 0.006), but not NICA latency (P = 0.126). ORT RI values showed a similar pattern. We found that NTG RI (47.2 ± 5.9% SEM) was different from NIMO RI (60.2 ± 4.6% SEM, P = 0.031) and different from saline RI (66.9 + 3.7% SEM, P = 0.006). Physiological experiments showed that MAP decreased to 45 to 50 mm Hg in all animals who became minimally responsive to external stimuli within 10 to 15 minutes of injection. Intergroup differences for MAP, body and brain oxygenation, and cerebral bloodflow were not statistically significant.
Acute hypotension induced by NIMO was protective of 2 categories of memory formation relevant to the clinical posttreatment period. Both immediate long-term associative memory consolidation as measured by the PA learning paradigm and delayed short-term working memory function as measured by the ORT paradigm were significantly improved compared to matched levels of hypotension induced by NTG. These results indicate the utility of further investigation of l-type calcium channel blockers as a potential means of preserving cognition in the setting of hypotensive and low flow states.
急性低血压可能与认知功能障碍有关。在缺氧的情况下,L 型钙通道阻滞剂对学习和记忆具有保护作用。我们假设尼莫地平(NIMO)和尼卡地平(NICA)引起的低血压与硝酸甘油(NTG)引起的低血压相比,会对长时和短时记忆有保护作用。
40 只瑞士-韦伯斯特小鼠(30 至 35 克,6 至 8 周)在第 0 天被动回避(PA)学习后立即随机分为 4 组进行腹腔注射:(1)NTG(30mg/kg);(2)NICA(40mg/kg);(3)NIMO(40mg/kg);(4)生理盐水。记录进入一个由聚碳酸酯管制成的平台进入一个管内的潜伏期(秒),在此期间会自动施加一个电击(0.3mA;2 秒持续时间)。在第 2 天,在没有电击的测试试验中记录潜伏期。大于 900 秒的潜伏期被赋值为这个值。较低的测试潜伏期表明长时联想记忆受损。另外 49 只老鼠被随机分为类似的组进行物体识别测试(ORT),并在第 0 天进行腹腔注射。ORT 通过利用老鼠更喜欢存在熟悉物体的新颖物体的倾向来测量短期记忆。在第 5 天的训练期间,将两个相同的物体放在一个圆形的竞技场中,老鼠会在 15 分钟内探索两个物体。在 1 小时后进行测试试验,用一个新物体替换一个熟悉的物体,持续 3 分钟。记忆完好的老鼠大约会花 65%的时间探索新物体。记忆受损的老鼠会花相等的时间探索每个物体。识别指数(RI)定义为探索新物体的时间与探索两个物体的时间之比,是记忆的衡量标准。在不同的组小鼠中进行平均动脉血压(MAP)、脑血流、身体和大脑氧合(PO2)的研究,以确定匹配程度的低血压剂量和每种治疗的生理特征。
不同条件下的 PA 潜伏期中位数如下:NTG(219.5±93.5 秒半四分位距[SIQR]),NICA(372.5±75.5 秒 SIQR),NIMO(540±200 秒 SIQR)和生理盐水(804±257.5 秒 SIQR)。使用秩方法分析 PA 潜伏期的显著差异。NTG 潜伏期明显短于 NIMO 潜伏期(P=0.012)和生理盐水潜伏期(P=0.006),但与 NICA 潜伏期无显著差异(P=0.126)。ORT RI 值也呈现出类似的模式。我们发现,NTG RI(47.2±5.9%SEM)与 NIMO RI(60.2±4.6%SEM,P=0.031)和生理盐水 RI(66.9+3.7%SEM,P=0.006)不同。生理实验表明,所有动物的 MAP 都降至 45 至 50mmHg,在注射后 10 至 15 分钟内,所有动物对外界刺激的反应都变得最小。组间 MAP、身体和大脑氧合、脑血流的差异没有统计学意义。
NIMO 引起的急性低血压对与临床治疗后时期相关的两种记忆形成具有保护作用。PA 学习范式测量的即时长时联想记忆巩固和 ORT 范式测量的延迟短期工作记忆功能均显著优于 NTG 诱导的匹配程度的低血压。这些结果表明,进一步研究 L 型钙通道阻滞剂作为在低血压和低流量状态下保持认知的潜在手段是有用的。