Werner C, Kochs E, Hoffman W E, Blanc I F, Schulte am Esch J
Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
Can J Anaesth. 1993 Aug;40(8):755-60. doi: 10.1007/BF03009772.
Pressure-passive perfusion beyond the upper limit of cerebral blood flow (CBF) autoregulation may be deleterious in patients with intracranial pathology. Therefore, monitoring of changes in CBF would be of clinical relevance in situations where clinical evaluation of adequate cerebral perfusion is impossible. Noninvasive monitoring of cerebral blood flow velocity using transcranial Doppler sonography (TCD) may reflect relative changes in CBF. This study correlates the effects of angiotensin-induced arterial hypertension on CBF and cerebral blood flow velocity in dogs. Heart rate (HR) was recorded using standard ECG. Catheters were placed in both femoral arteries and veins for measurements of mean arterial blood pressure (MAP), blood sampling and drug administration. A left ventricular catheter was placed for injection of microspheres. Cerebral blood flow velocity was measured in the basilar artery through a cranial window using a pulsed 8 MHz transcranial Doppler ultrasound system. CBF was measured using colour-labelled microspheres. Intracranial pressure (ICP) was measured using an epidural probe. Arterial blood gases, arterial pH and body temperature were maintained constant over time. Two baseline measures of HR, MAP, CBF, cerebral blood flow velocity and ICP were made in all dogs (n = 10) using etomidate infusion (1.5 mg.kg-1 x hr-1) and 70% N2O in O2 as background anaesthesia. Following baseline measurements, a bolus of 1.25 mg angiotensin was injected i.v. and all variables were recorded five minutes after the injection. Mean arterial blood pressure was increased by 76%. Heart rate and ICP did not change. Changes in MAP were associated with increases in cortical CBF (78%), brainstem CBF (87%) and cerebellum CBF (64%).(ABSTRACT TRUNCATED AT 250 WORDS)
在患有颅内病变的患者中,超过脑血流量(CBF)自动调节上限的压力被动灌注可能是有害的。因此,在无法对脑灌注是否充足进行临床评估的情况下,监测CBF的变化具有临床意义。使用经颅多普勒超声(TCD)对脑血流速度进行无创监测可能反映CBF的相对变化。本研究探讨了血管紧张素诱导的动脉高血压对犬CBF和脑血流速度的影响。使用标准心电图记录心率(HR)。将导管分别置于双侧股动脉和静脉中,用于测量平均动脉血压(MAP)、采血和给药。放置左心室导管用于注射微球。使用脉冲8MHz经颅多普勒超声系统通过颅骨窗口测量基底动脉的脑血流速度。使用彩色标记微球测量CBF。使用硬膜外探头测量颅内压(ICP)。随着时间的推移,动脉血气、动脉pH值和体温保持恒定。所有犬(n = 10)均使用依托咪酯输注(1.5mg·kg-1·hr-1)和70% N2O与O2混合气体作为背景麻醉,进行两次HR、MAP、CBF、脑血流速度和ICP的基线测量。在基线测量后,静脉注射1.25mg血管紧张素推注剂,并在注射后五分钟记录所有变量。平均动脉血压升高了76%。心率和ICP没有变化。MAP的变化与皮质CBF增加(78%)、脑干CBF增加(87%)和小脑CBF增加(64%)相关。(摘要截断于250字)