周期性复张与去复张致急性肺损伤猪模型中动脉血氧分压震荡向脑微循环的传递。

Transmission of arterial oxygen partial pressure oscillations to the cerebral microcirculation in a porcine model of acute lung injury caused by cyclic recruitment and derecruitment.

机构信息

Department of Anaesthesiology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

出版信息

Br J Anaesth. 2013 Feb;110(2):266-73. doi: 10.1093/bja/aes376. Epub 2012 Oct 26.

DOI:10.1093/bja/aes376

PMID:23103776

Abstract

BACKGROUND

Cyclic recruitment and derecruitment (R/D) play a key role in the pathomechanism of acute lung injury (ALI) leading to respiration-dependent oscillations of arterial partial pressure of oxygen (Pa(O(2))). These Pa(O(2)) oscillations could also be forwarded to the cerebral microcirculation.

METHODS

In 12 pigs, partial pressure of oxygen was measured in the thoracic aorta (Pa(O(2))) and subcortical cerebral tissue (Pbr(O(2))). Cerebral cortical haemoglobin oxygen saturation (Sbr(O(2))), cerebral blood flow (CBF), and peripheral haemoglobin saturation (Sp(O(2))) were assessed by spectroscopy and laser Doppler flowmetry. Measurements at different fractions of inspired oxygen (F(I(O(2)))) were performed at baseline and during cyclic R/D.

STATISTICS

frequency domain analysis, the Mann-Whitney test, linear models to test the influence of Pa(O(2)) and systolic arterial pressure (SAP) oscillations on cerebral measurements.

RESULTS

Parameters [mean (SD)] remained stable during baseline. Pa(O(2)) oscillations [10.6 (8) kPa, phase(reference)], systemic arterial pressure (SAP) oscillations [20 (9) mm Hg, phase(Pa(O(2))-SAP) -33 (72)°], and Sp(O(2))oscillations [1.9 (1.7)%, phase(Pa(O(2))-Sp(O(2))) 264 (72)°] were detected during lung R/D at 1.0. Pa(O(2)) oscillations decreased [2.7 (3.5) kPa, P=0.0008] and Sp(O(2)) oscillations increased [6.8 (3.9)%, P=0.0014] at F(I(O(2))) 0.3. In the brain, synchronized Pbr(O(2)) oscillations [0.6 (0.4) kPa, phase(Pa(O(2))-Pbr(O(2))) 90 (39)°], Sbr(O(2)) oscillations [4.1 (1.5)%, phase(Pa(O(2))-Sbr(O(2))) 182 (54)°], and CBF oscillations [198 (176) AU, phase(Pa(O(2))-CBF) 201 (63)°] occurred that were dependent on Pa(O(2)) and SAP oscillations.

CONCLUSIONS

Pa(O(2)) oscillations caused by cyclic R/D are transmitted to the cerebral microcirculation in a porcine model of ALI. These cyclic oxygen alterations could play a role in the crosstalk of acute lung and brain injury.

摘要

背景

循环招募和去招募（R/D）在导致动脉血氧分压（Pa(O(2)))呼吸依赖性振荡的急性肺损伤（ALI）发病机制中起关键作用。这些 Pa(O(2))) 振荡也可以传递到脑微循环。

方法

在 12 头猪中，测量胸主动脉（Pa(O(2)))和皮质下脑组织（Pbr(O(2)))中的氧分压。通过光谱和激光多普勒流量测量评估皮质血红蛋白氧饱和度（Sbr(O(2)))、脑血流量（CBF）和外周血红蛋白饱和度（Sp(O(2)))。在不同吸入氧分数（F(I(O(2))))下进行测量，在基线和循环 R/D 期间进行。

统计

频域分析，曼-惠特尼检验，线性模型测试 Pa(O(2))和收缩压（SAP）振荡对脑测量的影响。

结果

参数[平均值（SD)]在基线期间保持稳定。在 1.0 时，检测到肺 R/D 期间的 Pa(O(2))振荡[10.6（8）kPa，相位（参考）]、全身动脉压（SAP）振荡[20（9）mmHg，相位（Pa(O(2))-SAP)-33（72）°]和 Sp(O(2))振荡[1.9（1.7）%，相位（Pa(O(2))-Sp(O(2)))264（72）°]。在 F(I(O(2)))0.3 时，Pa(O(2))振荡减少[2.7（3.5）kPa，P=0.0008]，Sp(O(2))振荡增加[6.8（3.9）%，P=0.0014]。在大脑中，同步 Pbr(O(2))振荡[0.6（0.4）kPa，相位（Pa(O(2))-Pbr(O(2)))90（39）°]、Sbr(O(2))振荡[4.1（1.5）%，相位（Pa(O(2))-Sbr(O(2)))182（54）°]和 CBF 振荡[198（176）AU，相位（Pa(O(2))-CBF)201（63）°]发生，这些振荡依赖于 Pa(O(2))和 SAP 振荡。