摘要
目的 观察硝普钠(SNP)或硝酸甘油(NTG)控制性低血压(CH)和／或急性等容性血液稀释(ANH)对机体肠系膜、肾表面和脑表面局部微循环的影响，评价两药在CH或联合ANH中的应用。
方法 Wistar大鼠96只，随机分为肠系膜组(n=36)、肾表面组(n=30)和脑表面组(n=30)。上述三组均再随机分为ANH组(n=6)，SNP控制性低血压组(n=6)，NTG控制性低血压组(n=6)，ANH联合SNP控制性低血压组(n=6)，ANH联合NTG控制性低血压组(n=6)。肠系膜组还有空白对照组(n=6)。动物采用20％氨基甲酸乙酯肌注麻醉，气管切开，股动静脉分离置管。暴露肠系膜、肾表面微血管和脑表面软脑膜血管，在显微镜下直接观察活体微循环，记录微血管直径、血流等微循环变化并录象，统计肾脏表面交点计数值变化，或在激光多普勒下记录肾表面和脑表面的血流值(LDF值)的变化。采用0.005％的SNP或NTG溶液连续泵入进行CH，目标分别为平均动脉压(MAP)60mmHg、50mmHg、40mmHg和30～35mmHg。ANH采用放血同时琥珀酰明胶注射液等容量输入，目标血细胞比容(Hct)为25％左右。联合组采用两种方法的联合，先放血行等容血液稀释，再行控制性低血压，目标Hct和MAP同上。
结果 通过等容血液稀释将Hct降至25％左右：大鼠肠系膜微动脉的直径轻微增加(P＜0.05)，幅度不大，微静脉直径没有明显变化；肾表面交点计数值明显减少(P＜0.0001)，肾表面血流LDF值明显降低(P＜0.01)；脑微动脉的直径增大(P＜0.05)，而微静脉直径变化不明显，脑局部血流LDF值增加(P＜0.05)。
采用SNP或NTG行控制性低血压：大鼠肠系膜微动脉的血流等级在MAP≤40mmHg时明显降低(P＜0.001)，NTG降压在MAP≤50mmHg时肠系膜微动脉血管收缩(P＜0.05)，而SNP组各水平肠系膜微动静脉直径无变化；肾脏表面血流两组LDF值随血压的下降(MAP≤60mmHg时)明显降低(P＜0.01、0.001)，50mmHg时肾表面毛细血管数目开始减少(P＜0.05)，SNP组肾表面LDF值降低的斜率小；在各级血压水平脑微血管直径没有明显的变化，SNP降压组脑血流LDF值在各水平没有变化，而NTG降压在MAP≤50mmHg时，脑血流LDF值明显减少(P＜0.01)。
两种药物联合ANH时：大鼠肠系膜微血管直径无明显变化，血流等级在MAP≥50mmHg增加(SNP组)或不变(NTG组)，以后则降低(P＜0.001)；肾表面血流LDF值明显降低(P＜0.0001)，SNP降压联合ANH时肾表面血流降低曲线的斜率小；各血压水平，脑表面微动脉直径均增加，微静脉直径无变化，SNP联合组脑局部血流LDF值在MAP≥50mmHg时仍可保持，而NTG联合组脑血流LDF值随血压的降低而明显降低(P＜0.05)。
结论 一定深度的控制性低血压水平下药物不同，对微循环的影响也不同。但当血压明显下降后，对微循环的影响药物因素不再重要。ANH和CH对肠系膜、肾脏表面微血管和脑表面
Objective To observe the influences of controlled hypotension (CH) caused by sodium nitroprusside (SNP) or nitroglycerin (NTG) and/or acute normovolemic hemodilution ( ANH) on the microcirculation of mesentery and surface of kidney and brain of rat, and to evaluate the characteristics of the two drugs during CH or CH combined with ANH.
Methods 96 Wistar rats of either sex, were randomly selected for groups of mesentery (mes), kidney surface (kid) and brain surface (bra). Each of the three groups were further randomly divided to five subgroups of ANH, SNP-hypotension, NTG-hypotension, ANH combined with SNP-hypotension (SNPcom), and ANH combined with NTG-hypotension (NTGcom). Another subgroup of blank control in group of mesentery was built. Each of the subgroup contained 6 objects. The animal was anesthetized with 20% ethyl carbamate im, followed by tracheotomy, and femoral arterial and venous catheterizations were done. Then the microvasculature of mesentery, kidney and brain surface were exposed to the view of intravital microscopy. The diameter ((?)) and blood flow of the specified microvasculature were recorded and videotaped. Another blood flow value recorded was completed through laser Doppler flowmetry in kidney and brain group named LDF value. Point Intersection Count (PIC) of renal surface microcirculation was also noted. CH was achieved by continuous infusion of 0.005% SNP or NTG solution to mean arterial pressure (MAP) levels of 60 mmHg, 50 mmHg, 40 mmHg, 30~35mmHg. During ANH, target hematocrit (Hct) 25% was finished by blood extraction and meanwhile infusion of same volume of gelofusine iv. CH combined with ANH was available through ANH at first, then CH, with the same Hct and MAP as above.
Results When Hct decreased to 25% by ANH, (?)mes of arterioles increased with minor extent (P<0.05), no changes in that of venules. PICkid and LDFkid value decreased significantly ( P<0.0001, 0.01, respectively). (?)bra of arterioles increased (P<0.05), while no change was found in that of venules. LDFbra value increased (P<0.05).
During CH achieved by SNP or NTG, the blood flow grades of mesentery arterioles decreased significantly when MAP≤40mmHg (P<0.001). (?)mes of arterioles diminished when NTG lowed MAP≤50mmHg(P<0.05), but no change in (?)mes (including arterioles and venules) of all levels hypotension SNP induced. LDFkid value decreased significantly as MAP≤60mmHg in the two groups, and PICkid began to decline when MAP was 50mmHg (P<0.05), with the smaller slope in SNP hypotensive group of the formula describing the tendency of decreased LDFkid value. No significant change was found in (?)bra of
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