Keller E, Wietasch G, Ringleb P, Scholz M, Schwarz S, Stingele R, Schwab S, Hanley D, Hacke W
Department of Neurology, Neurocritical Care Unit, University of Heidelberg, Germany.
Crit Care Med. 2000 Feb;28(2):511-6. doi: 10.1097/00003246-200002000-00037.
To test the practicability of a new double indicator dilution method for bedside monitoring of cerebral blood flow (CBF) and to assess the clinical value of CBF monitoring as a prognostic tool for outcome and in therapy of elevated intracranial pressure (ICP) in patients with acute hemispheric stroke.
Prospective study. Clinical evaluation of a new method.
Neurological intensive care unit of a university hospital.
Ten patients with acute complete middle cerebral artery territory- or hemispheric infarctions.
Two combined fiberoptic thermistor catheters were placed in the right jugular bulb and in the thoracic aorta. Central venous injections of ice-cold indocyanine green dye were performed. CBF was estimated by calculating the mean transit times of the cold bolus and dye.
A total of 104 reproducible CBF measurements were obtained. No complications associated with the method were observed. Twelve pairs of measurements were performed within 30 mins with unchanged clinical conditions. The standard deviation of repeated measurements was 2.7 mL/100 g/min; the interrater reliability was between 0.95 and 0.99. The median CBF in patients who died (n = 4) was lower (27 mL/100g/min) than in those who survived (n = 6) (45 mL/100g/ min). Patients who died more frequently had low CBF values of <30 mL/100g/min (22 of 38; 58%) than patients who survived (10 of 54; 19%). A total of 37 CBF measurements were done during ICP elevation of >20 mm Hg. In patients who survived, ICP elevations were only associated with low CBF values in 5 of 26 events; whereas in patients who died, ICP elevations were associated with low CBF values in 8 of 11 events.
The new double indicator dilution technique may be suitable for serial bedside CBF measurement. It is easy to perform and can be rapidly repeated in the ICU environment. Validation of the method by comparison with standard methods is needed. The preliminary data indicate that bedside monitoring of CBF may give prognostic information for outcome and may guide therapy of elevated ICP in patients with malignant hemispheric infarction.
测试一种用于床边监测脑血流量（CBF）的新型双指示剂稀释法的实用性，并评估CBF监测作为急性半球性卒中患者预后工具以及颅内压（ICP）升高治疗中的临床价值。
前瞻性研究。对一种新方法进行临床评估。
大学医院的神经重症监护病房。
10例急性完全性大脑中动脉区域或半球梗死患者。
将两根组合式光纤热敏电阻导管分别置于右颈静脉球部和胸主动脉。进行中心静脉注射冰冷的吲哚菁绿染料。通过计算冷团注和染料的平均通过时间来估计CBF。
共获得104次可重复的CBF测量值。未观察到与该方法相关的并发症。在临床状况未改变的情况下，30分钟内进行了12对测量。重复测量的标准差为2.7 mL/100 g/min；评分者间信度在0.95至0.99之间。死亡患者（n = 4）的CBF中位数（27 mL/100g/min）低于存活患者（n = 6）（45 mL/100g/min）。死亡患者中CBF值<30 mL/100g/min的情况（38例中的22例；58%）比存活患者（54例中的10例；19%）更常见。在ICP升高>20 mmHg期间共进行了37次CBF测量。在存活患者中，26次事件中有5次ICP升高仅与低CBF值相关；而在死亡患者中，11次事件中有8次ICP升高与低CBF值相关。
新型双指示剂稀释技术可能适用于床边连续CBF测量。该方法易于实施，可在重症监护病房环境中快速重复。需要通过与标准方法比较来验证该方法。初步数据表明，床边CBF监测可能为预后提供信息，并可能指导恶性半球梗死患者ICP升高的治疗。
