St Jacques P J, Kirsch J R, Diringer M N, Traystman R J
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4963.
Am J Physiol. 1993 Jun;264(6 Pt 2):H2124-30. doi: 10.1152/ajpheart.1993.264.6.H2124.
We tested the hypothesis that severe insulin-induced hypoglycemia would depress cerebrovascular reactivity to CO2 via a mechanism that could be prevented by administration of the N-methyl-D-aspartate (NMDA) receptor antagonist MK-801 in infant piglets. Cerebral blood flow (CBF) was measured (microspheres) in 2- to 3-wk-old pentobarbital-anesthetized piglets during hypocapnia, normocapnia, and hypercapnia. Repeat CBF measurements were made either 1 (n = 5) or 2 h (n = 6) after insulin (200 U/kg iv) to elicit the time course of altered reactivity to CO2. Repeat CBF measurements were made in a third group (n = 5) 2 h after treatment with insulin and MK-801 (1.5 mg/kg iv bolus, 0.15 mg.kg-1.h-1 iv infusion) to determine whether any alteration in reactivity to CO2 was due to a mechanism involving the NMDA receptor. Cerebrovascular resistance and cerebral O2 consumption (CMRO2) were calculated with each measurement of CBF. Cerebrovascular response to CO2 (change in cerebrovascular resistance/change in arterial CO2 tension) was ablated in the group of piglets exposed to 1 or 2 h of hypoglycemia (preinsulin 1-h group, 0.038 +/- 0.007; preinsulin 2-h group, 0.023 +/- 0.004 mmHg.ml-1.min.100 g.mmHg CO2(-1)). Treatment with MK-801 did not alter normoglycemic CO2 reactivity (preinsulin, 0.032 +/- 0.005 mmHg.ml-1.min.100 g.mmHg CO2(-1)) and did not prevent ablation of cerebrovascular CO2 reactivity during hypoglycemia. CMRO2 was not affected by hypoglycemia in any group.(ABSTRACT TRUNCATED AT 250 WORDS)
严重胰岛素诱导的低血糖会通过一种机制抑制脑血管对二氧化碳的反应性,而在幼猪中给予N-甲基-D-天冬氨酸(NMDA)受体拮抗剂MK-801可预防该机制。在低碳酸血症、正常碳酸血症和高碳酸血症期间,对2至3周龄戊巴比妥麻醉的仔猪测量脑血流量(CBF)(微球法)。在注射胰岛素(200 U/kg静脉注射)后1小时(n = 5)或2小时(n = 6)进行重复CBF测量,以得出对二氧化碳反应性改变的时间进程。在第三组(n = 5)中,在胰岛素和MK-801(1.5 mg/kg静脉推注,0.15 mg·kg-1·h-1静脉输注)治疗2小时后进行重复CBF测量,以确定对二氧化碳反应性的任何改变是否归因于涉及NMDA受体的机制。每次测量CBF时计算脑血管阻力和脑氧消耗(CMRO2)。暴露于1或2小时低血糖的仔猪组中,脑血管对二氧化碳的反应(脑血管阻力变化/动脉二氧化碳张力变化)被消除(胰岛素前1小时组,0.038±0.007;胰岛素前2小时组,0.023±0.004 mmHg·ml-1·min·100 g·mmHg CO2-1)。MK-801治疗未改变正常血糖时的二氧化碳反应性(胰岛素前,0.032±0.005 mmHg·ml-1·min·100 g·mmHg CO2-1),也未预防低血糖期间脑血管二氧化碳反应性的消除。任何组中的CMRO2均未受低血糖影响。(摘要截断于250字)