Waaben J, Husum B, Hansen A J, Gjedde A
Department of Anesthesiology, Rigshospitalet (University Hospital), Copenhagen, Denmark.
Anesthesiology. 1989 Feb;70(2):299-304. doi: 10.1097/00000542-198902000-00020.
Hypocapnia and induced hypotension have been claimed by some to cause cerebral hypoxia because of insufficient perfusion. Regional cerebral blood flow (rCBF) and regional cerebral glucose utilization (rCMRglc) were measured simultaneously in the same animal subjected to hypocapnia or hypocapnia combined with induced arterial hypotension. The rCMRglc was measured with (3H) deoxyglucose and the rCBF with (14C) iodoantipyrine with the use of tissue biopsy methods and scintillation counting. Nineteen male Wistar rats were anesthetized with halothane and artificially ventilated. Anesthesia was maintained with nitrous oxide/oxygen (70:30) and succinylcholine. Six rats were maintained at normocapnia, six rats were ventilated to a PaCO2 of 20 mmHg, and seven animals were ventilated to PaCO2 20 mmHg combined with arterial hypotension of 50 mmHg (mean blood pressure) induced by infusion of adenosine. Although hypocapnia alone did not cause a statistically significant decrease of rCBF except in hippocampus, hypocapnia combined with hypotension resulted in a significant reduction of rCBF in four of seven regions when compared with hypocapnia alone; rCMRglc values were unchanged during hypocapnia. However, the addition of hypotension induced by adenosine led to a significant decline of glucose utilization in five of seven brain regions. In the present study the authors observed no increase of regional glucose utilization and hence no signs of cerebral ischemia during hypocapnia alone or combined with hypotension induced by adenosine.
一些人认为,低碳酸血症和诱导性低血压会因灌注不足而导致脑缺氧。在同一动物身上同时测量了低碳酸血症或低碳酸血症合并诱导性动脉低血压时的局部脑血流量(rCBF)和局部脑葡萄糖利用率(rCMRglc)。使用组织活检方法和闪烁计数法,用(3H)脱氧葡萄糖测量rCMRglc,用(14C)碘安替比林测量rCBF。19只雄性Wistar大鼠用氟烷麻醉并进行人工通气。用氧化亚氮/氧气(70:30)和琥珀酰胆碱维持麻醉。6只大鼠维持正常碳酸血症,6只大鼠通气使PaCO2达到20 mmHg,7只动物通气使PaCO2达到20 mmHg并通过输注腺苷诱导平均血压为50 mmHg的动脉低血压。虽然单独低碳酸血症除海马体外未导致rCBF有统计学意义的下降,但与单独低碳酸血症相比,低碳酸血症合并低血压导致7个区域中的4个区域rCBF显著降低;低碳酸血症期间rCMRglc值未改变。然而,腺苷诱导的低血压导致7个脑区中的5个区域葡萄糖利用率显著下降。在本研究中,作者观察到单独低碳酸血症或合并腺苷诱导的低血压时,局部葡萄糖利用率没有增加,因此没有脑缺血的迹象。