摘要
目的:探讨远隔缺血适应(RIC)对动脉瘤性蛛网膜下腔出血(aSAH)患者脑血流的影响。方法:选择2017年11月至2018年5月首都医科大学宣武医院神经外科重症监护病房连续收治的aSAH患者24例,所有患者在aSAH后72 h内接受动脉瘤夹闭和栓塞治疗,术后7 d内进行RIC干预5次。在RIC干预前、后采用经颅超声多普勒(TCD)评估脑血流,包括前循环:双侧大脑前动脉(ACA)、双侧大脑中动脉(MCA)、同侧MCA/颈内动脉(ICA)终末段血流速度比值(ratio);后循环:双侧大脑后动脉(PCA)、双侧椎动脉颅内段(VA)、基底动脉(BA)。RIC干预结束后复查头颅CT或MRI,判断有无新发梗死。结果:RIC干预后,患者前循环血流R-MCA、L-ACA及R-ratio较干预前升高(均P<0.05),升高幅度均<20%,其余参数差异无统计学意义(均P>0.05)。RIC干预后,患者后循环血流L-VA及BA较干预前升高(均P<0.05),升高幅度均<20%,其余参数差异无统计学意义(均P>0.05)。RIC干预结束后,CT或MRI均未发现新发脑梗死。结论:RIC干预在aSAH应用中对脑血流影响不明显,未导致新发脑梗死,其安全性得到初步证实。
Objective:To explore the effect of remote ischemic conditioning(RIC)on cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods:Included in this study were 24 a SAH patients consecutively admitted to the Intensive Care Unit of the Department of Neurosurgery at Xuanwu Hospital from November 2017 to May 2018.All patients underwent aneurysm clipping and embolization treatment within72 hours of aSAH and received RIC 5 times within 7 days after treatment.Before and after RIC intervention,transcranial doppler(TCD)was used to evaluate cerebral blood flow in the anterior circulation,including that of the bilateral anterior cerebral arteries(ACA),bilateral middle cerebral arteries(MCA),and the ipsilateral MCA/internal carotid artery(ICA)terminal section flow velocity ratio(ratio).The posterior circulation blood flow was also evaluated,including that at the bilateral posterior cerebral arteries(PCA),bilateral vertebral arteries(VA),and basilar artery(BA).Head CT or MRI recheck was performed after RIC intervention to evaluate the fresh infarctions.Results:Compared to data before RIC intervention,cerebral blood flow after intervention at the R-MCA,L-ACA,and R-ratio of the anterior circulation were increased(all P<0.05),with this increase being less than 20%,and the remaining parameters showed no significant difference(P>0.05).After RIC intervention,blood flow at the L-VA and BA of the posterior circulation were increased compared to those before intervention(all P<P.05),with this increase being less than 20%,and the other parameters showed no significant difference(P>0.05).Neither CT nor MRI showed fresh cerebral infarction after RIC intervention.Conclusion:RIC had no obvious effect on cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage and did not trigger fresh cerebral infarctions.This study confirms the preliminary safety of RIC.
作者
齐猛
王宁
程玮涛
蒋丽丹
陈文劲
曲鑫
徐跃峤
QI Meng;WANG Ning;CHENG Wei-tao;JIANG Li-dan;CHEN Wen-jin;QU Xin;XU Yue-qiao(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《神经损伤与功能重建》
2021年第2期76-78,94,共4页
Neural Injury and Functional Reconstruction
基金
北京市科技计划首都临床特色应用研究与成果推广(No.Z151100004015095)
北京市215高层次卫生技术人才学术骨干项目(No.2015-3-092)
首都医科大学宣武医院基础临床研究项目(No.X WYY201709)。
关键词
颅内动脉瘤
蛛网膜下腔出血
远隔缺血适应
经颅超声多普勒
脑血流
intracranial aneurysm
subarachnoid hemorrhage
remote ischemic conditioning
transcranial doppler
cerebral blood flow
