Inoue Yoshiaki, Shiozaki Tadahiko, Irisawa Taro, Mohri Tomoyoshi, Yoshiya Kazuhisa, Ikegawa Hitoshi, Tasaki Osamu, Tanaka Hiroshi, Shimazu Takeshi, Sugimoto Hisashi
Department of Traumatology and Acute Critical Medicine of Osaka University Graduate School of Medicine, Osaka, Japan.
Curr Neurovasc Res. 2007 Feb;4(1):49-54. doi: 10.2174/156720207779940725.
In this study, changes in cerebral blood flow (CBF) during acute phase after cardiopulmonary arrest (CPA) were examined in patients using stable Xenon enhanced computed tomography (Xe-CT). All patients (8) were stabilized hemodynamically within 4 hours after admission, and Xe-CT was performed immediately after restoration of spontaneous circulation (ROSC) at 8, 24, 48, 96 and 168 hours after ROSC. The progress of patients was monitored in other hospitals and clinics after discharge. Neurological outcomes were evaluated using the Glasgow outcome scale (GOS) 6 months after admission, and scores were compared against changes in CBF. Patients were grouped by prognosis. Four patients belonged to Group A (good recovery) and Group B (2 severely disabled, 2 in persistent vegetative state). The pattern of change in CBF after ROSC was found to be significantly different between Groups A and B (p <0.05). The CBF ratio relative to normal controls was higher in Group B than Group A within 48 hours after ROSC. However, at 48, 96, and 168 hours after ROSC, the opposite was observed: The CBF ratio was significantly higher in Group A than Group B (p<0.05). Based on these results, we concluded that CBF in the patients who survived after CPA changed remarkable especially within the first week. Furthermore, patients with abnormally low CBF that returns to supernormal within the first 48 hours following CPA can be expected to recover well neurologically.
在本研究中，使用稳定氙增强计算机断层扫描（Xe-CT）对心肺复苏（CPA）急性期患者的脑血流量（CBF）变化进行了检查。所有患者（8例）入院后4小时内血流动力学稳定，在自主循环恢复（ROSC）后8、24、48、96和168小时立即进行Xe-CT检查。出院后在其他医院和诊所对患者的病情进展进行监测。入院6个月后使用格拉斯哥预后量表（GOS）评估神经学预后，并将评分与CBF变化进行比较。根据预后对患者进行分组。4例患者属于A组（恢复良好），B组（2例严重残疾，2例持续性植物状态）。发现ROSC后A组和B组CBF的变化模式有显著差异（p<0.05）。ROSC后48小时内，B组相对于正常对照组的CBF比值高于A组。然而，在ROSC后48、96和168小时，观察到相反的情况：A组的CBF比值显著高于B组（p<0.05）。基于这些结果，我们得出结论，CPA后存活患者的CBF变化显著，尤其是在第一周内。此外，CPA后最初48小时内CBF异常低但恢复至超常水平的患者有望在神经学上恢复良好。
