Wendling W, Sadel S, Jimenez D, Rosenwasser R, Buchheit W
Department of Anesthesiology, Temple University Hospital, Philadelphia, PA 19140.
Eur J Anaesthesiol. 1994 Mar;11(2):81-7.
We examined the effects of Valsalva's manoeuvre and its four phase on heart rate, central venous pressure (CVP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and laser Doppler cerebellar cortical blood flow (CBF). Brief Valsalva manoeuvres increased CVP and markedly decreased MAP. Cerebral perfusion pressure significantly (P < or = 0.01, Dunnett's test) decreased during phases 2 and 3 of the Valsalva manoeuvre. Cortical blood flow closely paralleled CPP; CBF decreased to 59% of control during phase 2 and to 57% of control during phase 3 of the Valsalva manoeuvre. The MAP, CPP, and CBF all returned to baseline levels during phase 4 (the overshoot phase) of the Valsalva manoeuvre, and were not significantly greater than control. No autoregulatory change in cerebrovascular resistance occurred throughout the Valsalva manoeuvre. These results suggest that brief Valsalva manoeuvres, as employed during neurosurgical procedures, mainly confirm venous haemostasis, but must be used cautiously due to the marked haemodynamic changes.
我们研究了瓦尔萨尔瓦动作及其四个阶段对心率、中心静脉压（CVP）、平均动脉压（MAP）、脑灌注压（CPP）和激光多普勒小脑皮质血流量（CBF）的影响。短暂的瓦尔萨尔瓦动作可使CVP升高，并使MAP显著降低。在瓦尔萨尔瓦动作的第2和第3阶段，脑灌注压显著降低（P≤0.01，Dunnett检验）。皮质血流量与CPP密切平行；在瓦尔萨尔瓦动作的第2阶段，CBF降至对照值的59%，在第3阶段降至对照值的57%。在瓦尔萨尔瓦动作的第4阶段（过冲阶段），MAP、CPP和CBF均恢复到基线水平，且不显著高于对照值。在整个瓦尔萨尔瓦动作过程中，脑血管阻力未发生自动调节变化。这些结果表明，神经外科手术中采用的短暂瓦尔萨尔瓦动作主要用于确认静脉止血，但由于显著的血流动力学变化，必须谨慎使用。
