두부하위(-6˚)로의 체위변동이 말초혈류에 미치는 영향

Abstract

The purpose of the present study was to examine the hemodynamic responses, especially in arterial and skin blood flows, in conjunction with the changes of plasma catecholamine levels as an indirect marker of adrenergic tone during the early stage of head-down tilt (HDT), and to evaluate the early physiological regulatory mechanism in simulated weightlessness. Ten mongrel dogs, weighing 8~14kg, were intravenously anesthetized with nembutal, and postural changes were performed by using the tilting table. The postural changes were performed in the following order: supine, prone, HDT(-6˚) and lastly recovery prone position. The duration of each position was 30minutes. The measurements were made before, during and after each postural change. The arterial blood flow (Q) at the left common carotid and right brachial arteries was measured by the electromagnetic flowmeter. Blood pressure (BP) was directly measured by pressure transducer in the left brachial artery. To evaluate the peripheral blood flow, skin blood flow (q) was calculated by the percent changes of photoelectric pulse amplitude on the forepaw, and skin temperature was recorded. The peripheral vascular resistance(PR) was calculated by dividing respective mean BP values by Q of both sides of common carotid and brachial arteries. Heart rate (HR), respiratory rate (f) and pH, Po2, Pco2 and hematocrit of arterial and venous blood were also measured. The concentration of plasma epinephrine and norepinephrine was measured by radioenzymatic method. The results are summarized as follows: Tilting to head−down position from prone position, HR was initially increased (p<0.05) and BP was not significantly changed. While Q of the common carotid artery was decreased (p<0.05) and PR through the head was increased, Q of the brachial artery was increased (p<0.05) and then slightly decreased, on the whole revealing an increasing trend. Plasma norepinephrine was slightly decreased and the epinephrine was slightly increased. f was increased and arterial pH was increased (p<0.05). In conclusion, the central blood pooling during HDT shows an increased HR via Bainbridge reflex and an increased q of the forepaw and brachial Q, due to decreased PR which may be originated from the depressor reflex of cardiopulmonary baroreceptors. It is suggested that the blood flow to the brain was adequately regulated throughout HDT (-6˚) in spite of central blood pooling. And it is apparent that the changes of plasma norepinephrine level are inversely proportional to those of q of the forepaw, and the changes of epinephrine level are paralleled with those of the brachial Q. Key Words: Head-down tilt, Weightlessness, Carotid blood flow, Plasma catecholamines, Skin blood flow