糖尿病和外周血管疾病患者麻醉期间的脑血管二氧化碳反应性

Cerebrovascular CO2 reactivity during anesthesia in patients with diabetes mellitus and peripheral vascular disease.

作者信息

Kawata R, Nakakimura K, Matsumoto M, Kawai K, Kunihiro M, Sakabe T

机构信息

Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Ube, Japan.

出版信息

Anesthesiology. 1998 Oct;89(4):887-93. doi: 10.1097/00000542-199810000-00013.

DOI:10.1097/00000542-199810000-00013

PMID:9778006

Abstract

BACKGROUND

Diabetes mellitus (DM) and systemic atherosclerosis are risk factors for stroke. Although the origins of increased risk are complex, one possibility is that cerebrovascular reactivity is impaired and does not allow the brain to compensate for aberrations in physiology. The current study tested this issue by evaluating mean blood flow velocity of the middle cerebral artery (Vmca) and carbon dioxide reactivity during anesthesia in patients with DM and peripheral vascular disease (PVD).

METHODS

Fifty-two patients were observed: 20 patients with DM (the DM group), 12 patients with PVD (the PVD group), and 20 patients classified as American Society of Anesthesiologists physical status 1 or 2 (the control group). The Vmca was measured using transcranial Doppler ultrasonography during isoflurane-nitrous oxide anesthesia. After measuring baseline Vmca at a partial pressure of carbon dioxide in arterial blood (PaCO2) of 37.7 +/- 4.5 mmHg (mean +/- SD), measurements were repeated at a PaCO of 44.2 +/- 3.8 mmHg, and the carbon dioxide reactivity (absolute value: cm x s(-1) x mmHg(-1); relative value: percentage of baseline Vmca/mmHg) was calculated.

RESULTS

The baseline Vmca of the DM group (51 +/- 12 cm/s) was significantly greater than those of the control group (42 +/- 6 cm/s) and the PVD group (42 +/- 13 cm/s). The absolute and relative values of carbon dioxide reactivity in the DM group (3.1 +/- 1.3 cm x s(-1) x mmHg(-1); 6.3 +/- 2.4%/mmHg) were significantly greater than or equivalent to those of the control group (2.3 +/- 0.8 cm x s(-1) x mmHg(-1); 5.3 +/- 1.7%/mmHg), respectively. In the PVD group, the baseline Vmca was equivalent to the control group, but the carbon dioxide reactivity (1.1 +/- 0.5 cm x s(-1) x mmHg(-1) 2.8 +/- 1.2%/mmHg) was significantly less.

CONCLUSIONS

The patients with DM have increased baseline cerebral blood flow velocity and normal carbon dioxide reactivity during anesthesia. The patients with PVD have decreased carbon dioxide reactivity, but baseline flow velocity is maintained.

摘要

背景

糖尿病（DM）和全身性动脉粥样硬化是中风的危险因素。尽管风险增加的原因很复杂，但一种可能性是脑血管反应性受损，大脑无法补偿生理异常。本研究通过评估糖尿病和外周血管疾病（PVD）患者在麻醉期间大脑中动脉的平均血流速度（Vmca）和二氧化碳反应性来验证这一问题。

方法

观察了52例患者：20例糖尿病患者（糖尿病组），12例外周血管疾病患者（外周血管疾病组），以及20例美国麻醉医师协会身体状况分级为1或2级的患者（对照组）。在异氟烷-氧化亚氮麻醉期间，使用经颅多普勒超声测量Vmca。在动脉血二氧化碳分压（PaCO2）为37.7±4.5 mmHg（平均值±标准差）时测量基线Vmca后，在PaCO为44.2±3.8 mmHg时重复测量，并计算二氧化碳反应性（绝对值：cm×s⁻¹×mmHg⁻¹；相对值：基线Vmca/mmHg的百分比）。

结果

糖尿病组的基线Vmca（51±12 cm/s）显著高于对照组（42±6 cm/s）和外周血管疾病组（42±13 cm/s）。糖尿病组二氧化碳反应性的绝对值和相对值（3.1±1.3 cm×s⁻¹×mmHg⁻¹；6.3±2.4%/mmHg）分别显著高于或等同于对照组（2.3±0.8 cm×s⁻¹×mmHg⁻¹；5.3±1.7%/mmHg）。在外周血管疾病组中，基线Vmca与对照组相当，但二氧化碳反应性（1.1±0.5 cm×s⁻¹×mmHg⁻¹ 2.8±1.2%/mmHg）显著降低。