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在低温心肺旁路术后,大脑微循环的β-上腺素调节

F W Sellke¹, M Tofukuji, A Stamler

¹Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.

|December 31, 1997

概括

低温心肺绕道 (CPB) 损害了大脑血流的β-上腺体调节. 这种脱敏,与catecholamine暴露相关,影响了手术后的大脑微血管反应.

科学领域:

神经科学是一个神经科学.
心血管生理学心血管生理学
麻醉学麻醉学

背景情况:

β-上腺素-cAMP通路对于调节大脑血液流动至关重要.
之前的研究表明,在正常热心肺绕道 (CPB) 过程中,大脑β-上腺体受体介导放松减少.
低温CPB对这种途径的影响仍然不太清楚.

研究的目的:

研究中度和严重的低温CPB对β-上腺素-cAMP通路对大脑输液的调节的影响.
将这些效应与正常热CPB和无仪器对照进行比较.

主要方法:

猪接受了2小时的正常热 (37°C),中度低温 (25°C) 或严重低温 (16°C与1小时的循环停止) CPB.
在体外评估了对β-腺受体激动剂 (异二醇),腺酸环酶激活剂 (弗斯科林) 和cAMP模拟物 (8--cAMP) 的脑微血管反应.
测量了基线脑血流量和重新升温后的反应.

主要成果:

在重新加热后,所有组的基线脑血流在所有组中都是相似的.
与对照和正常热CPB相比,在中度和严重的低温CPB后,异二醇诱导的放松显著减少.
福斯科林诱导的放松仅在严重的低温循环停止后减少,而在正常热的CPB后,8-bromo-cAMP放松显著减少.

结论:

中度低温CPB和深刻的低温循环停止都比正常热的CPB更能使β-上腺素受体变得不敏感.
在CPB期间暴露于内源性甲醇胺可能有助于这种脱敏.
虽然基线大脑血流保持,但在低温CPB后,β-上腺素反应显著受损.

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