Andrews R J, Bringas J R, Alonzo G
Department of Neurosurgery, Stanford University Medical Center, California.
Neurosurgery. 1994 Mar;34(3):466-70; discussion 470. doi: 10.1227/00006123-199403000-00012.
Changes in ventilatory rate affect arterial blood pH and PCO2 within seconds to minutes, but the corresponding acute changes for cerebrospinal fluid (CSF) pH and PCO2 have been as well documented. Using our previously-described swine model of brain retraction ischemia, we examined changes in arterial and CSF pH and PCO2 with acute changes in ventilation in four animals. Newly developed fluorescent dye technology permitted near-instantaneous recording of CSF pH and PCO2 during acute hyperventilation (end-tidal PCO2 of 20 mm Hg) and acute hypoventilation (end-tidal PCO2 of 50 mm Hg). The Puritan-Bennett 3300 Intra-Arterial Blood Gas Monitor (PB3300) was used with the sensor placed in the CSF in the interhemispheric fissure posterior to the corpus callosum. The following data were gathered at 5, 15, 30, and 60 minutes after the ventilatory change: arterial pH and PCO2, end-tidal CO2, laser-Doppler cerebral blood flow, and CSF pH and PCO2. The baseline (normoventilation) values for arterial and CSF pH and PCO2 in swine were comparable to those in humans: arterial pH 7.44 and PCO2 43 mm Hg; CSF pH 7.31 and PCO2 55 mm Hg. Changes in pH and PCO2 with hyperventilation and hypoventilation occurred rapidly in both arterial blood and CSF. Steady-state values were reached within 15 minutes for hypoventilation, and 30 minutes for hyperventilation. The correlation between arterial and CSF values for both pH and PCO2 at 5, 15, 30, and 60 minutes were all very highly significant (P < 0.001) except for arterial and CSF PCO2 at 5 minutes (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
通气速率的变化在数秒到数分钟内会影响动脉血pH值和PCO₂,但脑脊液(CSF)pH值和PCO₂的相应急性变化也有充分记录。利用我们之前描述的脑回缩缺血猪模型,我们在四只动物中研究了通气急性变化时动脉血和脑脊液pH值及PCO₂的变化。新开发的荧光染料技术允许在急性过度通气(呼气末PCO₂为20 mmHg)和急性通气不足(呼气末PCO₂为50 mmHg)期间近乎即时记录脑脊液pH值和PCO₂。使用置于胼胝体后方半球间裂脑脊液中的传感器的Puritan-Bennett 3300动脉血气监测仪(PB3300)。在通气变化后5、15、30和60分钟收集以下数据:动脉血pH值和PCO₂、呼气末CO₂、激光多普勒脑血流量以及脑脊液pH值和PCO₂。猪动脉血和脑脊液pH值及PCO₂的基线(正常通气)值与人类相当:动脉血pH值7.44,PCO₂ 43 mmHg;脑脊液pH值7.31,PCO₂ 55 mmHg。动脉血和脑脊液中pH值和PCO₂随过度通气和通气不足的变化迅速发生。通气不足在15分钟内达到稳态值,过度通气在30分钟内达到稳态值。除了5分钟时动脉血和脑脊液PCO₂外,5、15、30和60分钟时动脉血和脑脊液pH值及PCO₂值之间的相关性均非常显著(P < 0.001)(5分钟时动脉血和脑脊液PCO₂的相关性为P < 0.01)。(摘要截断于250字)