动脉内注射维拉帕米对颈内动脉闭塞期间脑血管阻力的影响

Manipulation of cerebrovascular resistance during internal carotid artery occlusion by intraarterial verapamil.

作者信息

Joshi S, Young W L, Pile-Spellman J, Duong D H, Hacein-Bey L, Vang M C, Marshall R S, Ostapkovich N, Jackson T

机构信息

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.

出版信息

Anesth Analg. 1997 Oct;85(4):753-9. doi: 10.1097/00000539-199710000-00008.

DOI:10.1097/00000539-199710000-00008

PMID:9322451

Abstract

UNLABELLED

Occlusion of the internal carotid artery (ICA) results in acute cerebral hypotension. We hypothesized that during acute cerebral hypotension, in addition to physiological autoregulation, further arteriolar relaxation is possible by pharmacological means. We tested the feasibility of using intracarotid verapamil, a calcium channel blocker, to decrease the cerebrovascular resistance (CVR) and augment cerebral blood flow (CBF) at low postocclusion distal ICA pressures (PICA). Eleven patients undergoing trial occlusion of ICA were enrolled. Distal ICA or stump pressure, hemispheric CBF, and CVR were determined before and after carotid occlusion. During ICA occlusion, CBF and other physiological variables were determined before and after intracarotid verapamil. Two patients were excluded from the study. Carotid occlusion (n = 9) significantly decreased PICA (mean +/- SD, from 82 +/- 22 to 46 +/- 11 mm Hg, P = 0.001) and CBF (from 42 +/- 11 to 33 +/- 11 mL.100 g-1.min-1, P < 0.05). During occlusion, after intracarotid verapamil (3.9 +/- 1.6 mg), hemispheric CBF tended to increase from 31 +/- 11 to 35 +/- 14 mL.100 g-1.min-1 (P = 0.067). However, the percent increase in CBF after verapamil was a linear function of PICA (y = 1.01 x -32, n = 9, r2 = 0.84, P = 0.006). The decrease in CBF during carotid occlusion suggests that near maximal cerebral autoregulatory vasodilation had occurred, although our results indicate that it may be feasible to further augment CBF by pharmacological means during acute cerebral hypotension.

IMPLICATIONS

When the internal carotid artery is occluded during neurosurgical procedures, there may be a significant reduction in cerebral perfusion. The authors have demonstrated that the intraarterial administration of verapamil increases cerebral blood flow as a linear function of cerebral artery pressure. Intracarotid injection of vasodilators may augment cerebral blood flow during acute cerebral hypotension.

摘要

未标记

颈内动脉（ICA）闭塞会导致急性脑低血压。我们假设在急性脑低血压期间，除了生理自动调节外，通过药理学方法进一步使小动脉舒张是可能的。我们测试了使用颈动脉内维拉帕米（一种钙通道阻滞剂）在闭塞后ICA远端低压力（PICA）时降低脑血管阻力（CVR）并增加脑血流量（CBF）的可行性。招募了11名接受ICA试验性闭塞的患者。在颈动脉闭塞前后测定ICA远端或残端压力、半球CBF和CVR。在ICA闭塞期间，在颈动脉内注射维拉帕米前后测定CBF和其他生理变量。两名患者被排除在研究之外。颈动脉闭塞（n = 9）显著降低了PICA（平均值±标准差，从82±22降至46±11 mmHg，P = 0.001）和CBF（从42±11降至33±11 mL·100 g-1·min-1，P < 0.05）。在闭塞期间，颈动脉内注射维拉帕米（3.9±1.6 mg）后，半球CBF倾向于从31±11增加至35±14 mL·100 g-1·min-1（P = 0.067）。然而，维拉帕米后CBF的增加百分比是PICA的线性函数（y = 1.01x - 32，n = 9，r2 = 0.84，P = 0.006）。颈动脉闭塞期间CBF的降低表明已发生接近最大程度的脑自动调节血管舒张，尽管我们的结果表明在急性脑低血压期间通过药理学方法进一步增加CBF可能是可行的。