临界关闭压对于正常大鼠脑血流自动调节的作用

摘要/Abstract

摘要：

目的探讨正常大鼠脑血流自动调节范围内和超出自动调节范围后，临界关闭压（critical closing pressure，CCP）对脑血流的调控作用。方法健康雄性SD大鼠随机分为升压组和降压组各70只，除去手术失败的动物，完整采集数据升压组69只，降压组54只。分别以10～15 mmHg为一级逐步升高、降低血压，同步记录大鼠大脑中动脉血流速度（cerebral blood flow velocity，CBFV）和有创血压，绘制自动调节曲线，并按照CCP理论计算CCP 和血管面积阻力指数（resistance area product，RAP），分析血流动力参数之间，以及血流动力学参数与血压变化间的关系。结果动脉血压升高或降低过程中，正常大鼠的脑血流自动调节上、下限分别为（148.12±7.49）mmHg、（62.96±3.34）mmHg。脑血流自动调节范围内，CBFV随动脉血压改变轻微，超出自动调节范围后，CBFV 随动脉血压升高明显增加（r =0.896，P =0.000），或随动脉血压降低明显减小（r =0.945，P＜0.001）。 CCP变化恰好与CBFV相反，自动调节范围内随动脉血压改变明显，与平均动脉压呈明显正相关（升压 r =0.967、降压r =0.969，P均＜0.001），超出自动调节范围后改变量明显减小。RAP也有CCP的类似趋势，但数值变化量不是很明显，只有降压过程自动调节范围内的改变量明显大于超出自动调节范围后。结论大鼠脑血流调控过程中，自动调节有效范围内，脑血流的稳定与CCP和RAP密切相关，尤其是 CCP。微动脉血管紧张度和微动脉直径变化共同参与了脑血流的调控。

文章导读： 通过对大鼠降压和升压过程中临界关闭压、血管面积阻力指数等血流动力学参数的计算，发现自动调节有效范围内，脑血流的稳定与临界关闭压和血管面积阻力指数密切相关。

关键词: 脑血流; 自动调节; 临界关闭压; 经颅多普勒

Abstract:

Objective To validate the role of the model of critical closing pressure (CCP) of normal rats on cerebral blood regulation in and out the range of cerebral blood flow autoregulation (CBFA). Methods Total 123 rats were randomly divided into rising blood pressure group (69) and lowering blood pressure group (54), after excluding unsuccessful operating animals. Higher and lower blood pressure were induced by gradually increasing or decreasing mean arterial blood pressure (MABP) per 10~15 mmHg. The cerebral blood flow velocity (CBFV) and artery pressure were monitored simultaneously and the curves of CBFA were analyzed. The values of CCP and resistance area product (RAP) were worked out according to CCP theory. The relationship between hemodynamics parameters and the association between hemodynamics and the changes of blood pressure were evaluated. Results The upper limit of autoregulation (ULA) and the lower limit of autoregulation (LLA) of normal rats were (148.12±7.49) mmHg and (62.96±3.34) mmHg, respectively. The rising and lowering blood pressure group, when MABP changed in the range of CBFA, the CBFV changed little. Beyond the limits of CBFA, CBFV increased (r =0.869, P <0.001) following MABP rising, and CBFV decreased (r =0.945, P <0.001) when MABP declining. CCP correlated with MABP positively (r =0.967, 0.969, P =0.000). RAP had a similar tendency of CCP. But only in the hypotensive process,the variable quantity of RAP in the range of CBFA was greater than out the range. Conclusion In the range of CBFA, cerebral blood flow is closely related to CCP and RAP, especially CCP. Cerebrovascular tone and the changes of arterioles’ diameter contribute to the process of cerebral autoregulation.

Key words: Cerebral blood flow; Autoregulation; Critical closing pressure; Transcranial Doppler

王文君，高庆春，陈建文，郭健，张伟劲，傅贤，李现亮. 临界关闭压对于正常大鼠脑血流自动调节的作用[J]. 中国卒中杂志, 2016, 11(01): 34-41.

WANG Wen-Jun, GAO Qing-Chun, CHEN Jian-Wen, et al.. Role of Critical Closing Pressure to Cerebral Blood Flow Autoregulation on Normal Rats[J]. Chinese Journal of Stroke, 2016, 11(01): 34-41.

参考文献

1 Panerai RB. The critical closing pressure of the cerebral

circulation[J]. Med Eng Phys, 2003, 25:621-632.

2 Mcculloch TJ, Turner MJ. The effects of hypocapnia

and the cerebral autoregulator y response on

cerebrovascular resistance and apparent zero flow

pressure during isof lurane anesthesia[J]. Anesth

Analg, 2009, 108:1284-1290.

3 高庆春, 黄如训, 陈秀梅, 等. 采用临界关闭压无创

测定健康人脑血流自动调节功能[J]. 中国临床康复,

2005, 9:73-75.

4 Aaslid R, Lash SR, Bardy GH, et al. Dynamic

pressure--flow velocity relationships in the human

cerebral circulation[J]. Stroke, 2003, 34:1645-1649.

5 Jones SC, Radinsky CR, Furlan AJ, et al. Cortical

NOS inhibition raises the lower limit of cerebral blood

flow-arterial pressure autoregulation[J]. Am J Physiol,

1999, 276:1253-1262.

6 Taylor JA, Tan CO, Hamner JW. Assessing cerebral

autoregulation via oscillatory lower body negative

pressure and projection pursuit regression[J]. J Vis

Exp, 2014, (94);doi:10. 3791/51082.

7 Calviere L, Nasr N, Arnaud C, et al. Prediction

of delayed cerebral ischemia after subarachnoid

hemorrhage using cerebral blood flow velocities and

cerebral autoregulation assessment[J]. Neurocrit Care,

2015, 23:253-258.

8 Lucas SJ, Tzeng YC, Galvin SD, et al. Influence of

changes in blood pressure on cerebral perfusion and

oxygenation[J]. Hypertension, 2010, 55:698-705.

9 Panerai RB, White RP, Markus HS, et al. Grading of

cerebral dynamic autoregulation from spontaneous

fluctuations in arterial blood pressure[J]. Stroke, 1998,

29:2341-2346.

10 Bokkers RP, Wessels FJ, Van Der Worp HB, et al.

Vasodilatory capacity of the cerebral vasculature

in patients with carotid artery stenosis[J]. Am J

Neuroradiol, 2011, 32:1030-1033.

11 Marzban C, Illian PR, Morison D, et al. A method

for estimating zero-f low pressure and intracranial

pressure[J]. J Neurosurg Anesthesiol, 2013, 25:25-32.

12 Aaslid R, Blaha M, Sviri G, et al. Asymmetric

dynamic cerebral autoregulatory response to cyclic

stimuli[J]. Stroke, 2007, 38:1465-1469.

13 Weyland A, Buhre W, Grund S, et al. Cerebrovasculartone rather than intracranial pressure determines the

effective downstream pressure of the cerebral circulation

in the absence of intracranial hypertension[J]. J

Neurosurg Anesthesiol, 2000, 12:210-216.14 Gupta MM, Bithal PK, Dash HH, et al. Effects of

stellate ganglion block on cerebral haemodynamics as

assessed by transcranial Doppler ultrasonography[J].

Br J Anaesth, 2005, 95:669-673.

[1]	嵇朋, 屈雪萍, 江利敏, 郭向东, 孙根, 刘松灿, 孟凡超, 李小刚. 阻塞型睡眠呼吸暂停低通气综合征对急性缺血性卒中患者脑血管反应性的影响[J]. 中国卒中杂志, 2021, 16(10): 1034-1038.
[2]	岳庆雄, 刘佳, 周瑜, 余雪慧, 沙雨佳, 王涛, 李世军. 基于经食管超声心动图的卵圆孔未闭形态与隐源性卒中的关系研究[J]. 中国卒中杂志, 2021, 16(09): 915-920.
[3]	张哲，濮月华，于蕾，段婉莹，米东华，刘丽萍. 急性前循环缺血性卒中血管内治疗术后早期脑血流自动调节功能与预后关系研究[J]. 中国卒中杂志, 2020, 15(12): 1299-1305.
[4]	安立澌，曲凯，邢英琦. 因卒中起病经血管超声诊断为永存舌下动脉1例[J]. 中国卒中杂志, 2020, 15(12): 1337-1341.
[5]	陈洁，刘嘉，董培，董可辉，莫大鹏，王伊龙，赵性泉，龚浠平. 特发性高颅压患者脑血流自动调节研究[J]. 中国卒中杂志, 2020, 15(11): 1218-1222.
[6]	何倩倩，伏兵，张照婷，李敏，董万利. H型高血压患者脑白质病变和脑血流动力学的特点[J]. 中国卒中杂志, 2020, 15(01): 22-27.
[7]	李朝霞, 董培, 白亚秋, 赵性泉. 对比不同体位对经颅多普勒增强试验诊断偏头痛患者右向左分流的影响研究[J]. 中国卒中杂志, 2019, 14(10): 1011-1014.
[8]	郭蓉，陈新，李向南，张思艺，殷丽丽，蔺慕会，任占秀. 神经血管超声对伴有椎动脉重度狭窄的后循环脑梗死支架治疗围手术期血流动力学评估2例[J]. 中国卒中杂志, 2019, 14(10): 1060-1065.
[9]	刘玮，卢烁，刘尊敬. 经颅多普勒超声在脑侧支循环评估中的临床应用[J]. 中国卒中杂志, 2019, 14(08): 786-791.
[10]	刘俊艳. 重视侧支循环的影像学评估在卒中诊疗决策中的应用[J]. 中国卒中杂志, 2019, 14(07): 635-638.
[11]	韩珂，胡汉华. 脑血流自动调节：从理论到临床转化及检查流程的标准化[J]. 中国卒中杂志, 2019, 14(03): 195-206.
[12]	吕珊，郭珍妮，靳航，孙欣，贾美岩，马虹印，吕玉丹，邱全利，刘嘉，杨弋. 癫痫患者动态脑血流自动调节功能研究[J]. 中国卒中杂志, 2019, 14(03): 231-239.
[13]	郭珍妮，孙欣，刘嘉，孙惠杰，赵英凯，马虹印，徐保峰，王钟秀，李超，颜秀丽，周宏伟，张鹏，靳航，杨弋（翻译：王焱1）. 初级侧支循环对脑血流自动调节功能的影响[J]. 中国卒中杂志, 2019, 14(03): 240-246.
[14]	胡鸣一，黄艳露，可成名，姜振威，韩珂. 下肢袖带释放实验在脑血流自动调节评估中的应用现状[J]. 中国卒中杂志, 2019, 14(03): 248-254.
[15]	纪乃方，王政严，韩珂，胡汉华. 静息状态的动态脑血流自动调节：检查方法及临床应用[J]. 中国卒中杂志, 2019, 14(03): 255-259.