von Reutern G M, Hetzel A, Birnbaum D, Schlosser V
Department of Neurology, University of Freiburg, Federal Republic of Germany.
Stroke. 1988 Jun;19(6):674-80. doi: 10.1161/01.str.19.6.674.
Blood flow velocity of the middle cerebral artery was monitored during cardiopulmonary bypass procedures by means of transcranial Doppler ultrasonography. Our investigation was carried out in a group of 16 patients with severe carotid stenosis or occlusion and in a control group of 42 patients with no or stenosis of less than 50% local diameter reduction. After onset of cardiopulmonary bypass, both groups showed a short unstable phase followed by increased blood flow velocity (10% increase ipsilateral to the obstruction, 27% increase in the control group). Just before rewarming, blood flow velocity was still comparable to (control group -3%) or higher than (ipsilateral to obstructions +14%) prebypass values. Analysis of three patients with postoperative diffuse encephalopathy did not reveal reduced blood flow during cardiopulmonary bypass as a relevant factor. Two of the three showed luxury perfusion. Reduced perfusion due to carotid obstruction was not observed during cardiopulmonary bypass and therefore cannot be considered a significant risk factor for the development of intraoperative stroke.
在心肺转流手术过程中，通过经颅多普勒超声监测大脑中动脉的血流速度。我们的研究针对16例患有严重颈动脉狭窄或闭塞的患者以及42例无颈动脉狭窄或局部直径缩小小于50%的对照组患者展开。心肺转流开始后，两组均出现短暂的不稳定期，随后血流速度增加（阻塞同侧增加10%，对照组增加27%）。在复温前，血流速度仍与体外循环前值相当（对照组降低3%）或高于该值（阻塞同侧增加14%）。对3例术后弥漫性脑病患者的分析未发现心肺转流期间血流减少是一个相关因素。其中2例出现过度灌注。在心肺转流期间未观察到因颈动脉阻塞导致的灌注减少，因此不能将其视为术中发生卒中的重要危险因素。
