烟雾病患者麻醉期间的局部皮质脑血流及对二氧化碳的反应

Local cortical cerebral blood flow and response to carbon dioxide during anesthesia in patients with moyamoya disease.

作者信息

Yusa T, Yamashiro K

机构信息

Department of Anesthesiology and Neurosurgery, University of the Ryukyus, Faculty of Medicine, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan.

出版信息

J Anesth. 1999;13(3):131-5. doi: 10.1007/s005400050043.

DOI:10.1007/s005400050043

PMID:14530930

Abstract

PURPOSE

The CO(2) reactivity of cortical cerebral vessels and local cortical blood flow (l-CoBF) were evaluated during anesthesia in patients with moyamoya disease who were undergoing revascularization surgery.

METHODS

Using laser-Doppler flowmetry, the CO(2) reactivity of cortical cerebral vessels and l-CoBF were measured continuously in five patients at the local surgical field of the middle cerebral artery (MCA) territory.

RESULTS

Local-CoBF values obtained during the normocapnic condition varied from site to site of gyrus in the MCA region (0-73 ml. 100 g(-1).min(-1)). Local-CoBF was maximal at 39-43 mmHg of the PaCO(2) range, and decreased above and below this range. The response of l-CoBF to CO(2) was larger at the sites where the maximal level was obtained during normocapnia. In two patients, l-CoBF decreased by about 50%, and remained law even 40 min after administration of acetazolamide.

CONCLUSION

In patients with moyamoya disease, l-CoBF values obtained during the normocapnic condition varied from site to site of gyrus, and not only hypocapnia but also hypercapnia decreased l-CoBF within the MCA region.

摘要

目的

评估烟雾病患者在接受血管重建手术麻醉期间大脑皮质脑血管的二氧化碳反应性及局部皮质血流量（l-CoBF）。

方法

使用激光多普勒血流仪，在5例患者大脑中动脉（MCA）区域的局部手术视野连续测量皮质脑血管的二氧化碳反应性及l-CoBF。

结果

在正常碳酸血症状态下获得的局部CoBF值在MCA区域的不同脑回部位有所不同（0 - 73 ml·100 g⁻¹·min⁻¹）。局部CoBF在PaCO₂范围为39 - 43 mmHg时最大，在此范围之上和之下均降低。在正常碳酸血症期间获得最大水平的部位，l-CoBF对二氧化碳的反应更大。在2例患者中，l-CoBF下降约50%，即使在给予乙酰唑胺40分钟后仍保持较低水平。