Department of Neurology, Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, United States.
Department of Neurology, Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, United States.
Handb Clin Neurol. 2021;177:295-317. doi: 10.1016/B978-0-12-819814-8.00015-9.
Hemodynamics is the study of blood flow, where parameters have been defined to quantify blood flow and the relationship with systemic circulatory changes. Understanding these perfusion parameters, the relationship between different blood flow variables and the implications for ischemic injury are outlined in the ensuing discussion. This chapter focuses on the hemodynamic changes that occur in ischemic stroke, and their contribution to ischemic stroke pathophysiology. We discuss the interaction between cardiovascular response and hemodynamic changes in stroke. Studying hemodynamic changes has a key role in stroke prevention, therapeutic implications and prognostic importance in acute ischemic stroke: preexisting hemodynamic and autoregulatory impairments predict the occurrence of stroke. Hemodynamic failure predisposes to the formation of thromboemboli and accelerates infarction due to impairing compensatory mechanisms. In ischemic stroke involving occlusion of a large vessel, persistent collateral circulation leads to preservation of ischemic penumbra and therefore justifying endovascular thrombectomy. Following thrombectomy, impaired autoregulation may lead to reperfusion injury and hemorrhage.
血流动力学是研究血流的科学，其中定义了参数来量化血流和与全身循环变化的关系。在接下来的讨论中，概述了理解这些灌注参数、不同血流变量之间的关系以及对缺血性损伤的影响。本章重点讨论了缺血性中风中发生的血流动力学变化及其对缺血性中风病理生理学的贡献。我们讨论了中风中心血管反应和血流动力学变化之间的相互作用。研究血流动力学变化在中风预防、治疗意义和急性缺血性中风的预后重要性方面具有关键作用：预先存在的血流动力学和自动调节障碍预测中风的发生。血流动力学衰竭易导致血栓栓塞的形成，并由于破坏了代偿机制而加速梗死。在涉及大血管闭塞的缺血性中风中，持续的侧支循环导致缺血半影的保存，因此 justifies 血管内血栓切除术。血栓切除术后，自动调节受损可能导致再灌注损伤和出血。
