非洲灰鸚鵡動脈壓與骨內壓之相關性

The Relationship between Intra-arterial Pressure and Intra-osseous Pressure in African Grey Parrots (Psittacus erithacus)

彭筠文(Yun-Wen Peng)

指導教授 ： 季昭華

國立臺灣大學/獸醫專業學院/臨床動物醫學研究所/碩士(2019年)

https://doi.org/10.6342/NTU201902610

摘要

無論是人類醫學或是動物醫學中，血壓被視為是生命跡象的重要指標之一，可以反映出系統性血液灌流量的狀況。然而，血壓測量在鳥類因受限於其特殊生理與解剖構造、間接式血壓測量的不準確性，而無法發展為例行性理學檢查中的一環。骨內導管為目前鳥類臨床醫療中常使用的輸液途徑，利用骨髓腔與血液循環之通道讓體型小、低血壓等血管不易辨識之個體有另一個功能等同於靜脈注射的途徑。此外，許多研究皆顯示，鳥類設置骨內導管後所能維持的時間較靜脈導管持久，而在人類醫學中，也時常面臨相似的問題，無論是血管細小的新生兒或是急重症病患，選擇設置骨內導管為更迅速、便利且不引起太多的併發症的選擇。因此，近年來開始出現骨內壓與系統性血壓相關性之研究，試圖找出骨內壓力做為臨床血壓評估的可行性。
本次研究中，將使用12隻非洲灰鸚鵡(Psittacus erithacus)做為實驗對象，主要考量該物種在國內外有多篇針對其心血管系統之構造與相關疾病之研究，因此選用此物種將使本研究方法設計更為準確且研究結果也將更具有臨床意義。所有實驗對象皆於全身麻醉下，以24G針於深橈骨動脈設置動脈導管，並以22G針於尺骨骨髓腔設置骨內導管，兩導管各自連結壓力偵測器以便記錄，總記錄過程為十分鐘。將每隻動物於每分鐘的測量中，任取十個完整波形進行統計試驗，結果顯示動脈壓為常態變數(P>0.05)，骨內壓則不為常態變數(P<0.05)。於十分鐘內動脈的平均收縮壓、平均壓及舒張壓分別為118.90±11.66 (94.50-136.02)mmHg、94.86±17.97(66.89-129.51)mmHg以及79.66±20.42(49.05-117.87)mmHg。十分鐘內的骨內平均壓為49.17±29.94(2.03-93.21)mmHg，而平均心跳則為每分鐘315.19±101.14(158.20-490.60)下。動脈平均壓壓力值與骨內平均壓壓力值不具有統計相關性，然而骨內平均壓壓力值與心跳呈正相關，其相關係數為0.58。
本實驗無法證實骨內壓能夠取代動脈壓做為血壓監控的取代，然而本實驗仍顯示其設置方法與時間相較動脈導管更為簡單且短，因此於臨床應用上仍具有極佳潛力，需待進一步研究以確立骨內壓於臨床上的應用價值與可行性。

關鍵字

非洲灰鸚鵡, 血壓, 動脈, 骨內途徑, 相關性, 鳥類

並列摘要

Blood pressure is one of the vital signs in clinical medicine, its’ reading provides a direct evaluation of systemic circulation. However, in birds, blood pressure measurement is not performed routinely during physical examination owing to special physiologic, anatomic limitations and inaccuracy of indirect blood pressure measurement in avian patients. Intraosseous catheter is now the most commonly used route in avian fluid therapy, especially for those small sized or are hypotensive that makes the vessel inaccessible. In human medicine, similar limitations were encountered in neonatal or critically illed patients, some research has found that intraosseous catheter can be placed more quickly, easily, and with lower complications. Hence, recently, more and more researches has focused on the relationship between intraosseous pressure and arterial pressure, and try to find if the intraosseous pressure measurement could replace blood pressure measurement in clinical condition
In this study, we used 12 healthy sub-adult or adult African grey parrots (Psittacus erithacus) as experimental subjects. Each bird was maintained under general anesthesia condition, a 24 gauge catheter was installed into the deep radial artery and a 22 guage needle was installed into the ulna medullary cavity respectively. Both catheters connected to a disposable pressure sensor, and arterial pressure waveform and intraosseous pressure waveforms were recorded for 10 minutes. The arterial pressure values were normally distributed while the intraosseous pressure values were not. The average of arterial systolic, mean, diastolic pressure values are 118.90±11.66(94.50-136.02) mmHg, 94.86±17.97(66.89-129.51) mmHg and 79.66±20.42(49.05-117.87) mmHg. The average of intraosseous mean pressure values is 49.17± 29.94(2.03-93.21) mmHg, and the average heart rate is 315.19± 101.14(158.20-490.60) beat per minute. There’s no correlation between arterial pressure values and intraosseous pressure values. A positive relationship between heart rate and mean intraosseous pressure values was found and the correlation coefficient was 0.58.
Though future research may need to determine the efficacy of intraosseous pressure, based on its easier and less time consuming techniques, it is still a potential method for further clinical use in avian patients.

並列關鍵字

African grey parrots, Psittacus erithacus, blood pressure, intraosseous route, relationship, avian

參考文獻

Acierno, M. J., Da Cunha, A., Smith, J., Tully Jr, T. N., Guzman, D. S. M., Serra, V., & Mitchell, M. A. (2008). Agreement between direct and indirect blood pressure measurements obtained from anesthetized Hispaniolan Amazon parrots. Journal of the American Veterinary Medical Association, 233(10), 1587-1590.

Atsumi, T., & Kuroki, Y. (1990). Vascular changes of idiopathic necrosis of the femoral head. In Bone circulation and bone necrosis (pp. 311-315). Springer, Berlin, Heidelberg.

Azuma, H. (1964). Intraosseous pressure as a measure of hemodynamic changes in bone marrow. Angiology, 15(9), 396-406.

Beaufrère, H., Ammersbach, M., Reavill, D. R., Garner, M. M., Heatley, J. J., Wakamatsu, N., Nevarez J. G. & Tully, T. N. (2013). Prevalence of and risk factors associated with atherosclerosis in psittacine birds. Journal of the American Veterinary Medical Association, 242(12), 1696-1704.

Beaumont, G. D. (1967). The intraosseous vasculature of the ulna of Gallus domesticus. Journal of anatomy, 101(Pt 3), 543.