Department of Neurosurgery, University of Kentucky Hospital, Lexington, Kentucky, USA.
Department of Behavioral Science, University of Kentucky Hospital, Lexington, Kentucky, USA.
World Neurosurg. 2022 Feb;158:e317-e322. doi: 10.1016/j.wneu.2021.10.171. Epub 2021 Oct 30.
Ischemic stroke is a prevalent, devastating disease with high morbidity and mortality. Despite extensive research using animal models, significant gaps remain in understanding the pathological processes in human stroke. We previously developed a tissue bank to analyze the blood immediately proximal and distal to an intracranial thrombus in patients undergoing mechanical thrombectomy (ClinicalTrials.gov identifier, NCT03153683). Our goal for the present project was to evaluate the blood gas changes and acid/base balance during stroke and determine how vascular collateralization affects these changes.
We analyzed the blood samples and computed tomography angiography collateral scores from the first 62 patients in the BACTRAC (Blood and Clot Thrombectomy Registry and Collaboration) registry. The bicarbonate, partial pressure of oxygen, and partial pressure of carbon dioxide (pCO) values of the intracranial (distal) and systemic (proximal) arterial blood relative to the occlusive thrombus were analyzed. Analysis of the group differences in systemic and intracranial blood gas values was also performed.
The partial pressure of oxygen, pCO, and bicarbonate levels were all significantly higher in the systemic blood than in the intracranial blood (P < 0.001 for all) at thrombectomy. Collateralization did not significantly affect the distal blood gas values. Compared with the female patients, the male patients had had higher systemic pCO values (39.8 vs. 36.6 mm Hg; P = 0.0065) and lower systemic and intracranial pH values (7.351 vs. 7.392; P = 0.0047).
The arterial blood gases differed immediately proximal and distal to thrombi in large vessel occlusive stroke. Although vascular collateralization did not appear to affect the blood gas changes, some blood gas values differed between men and women. The changes in bicarbonate and pCO suggested a compensatory acid-base process occurring at the time of infarction.
缺血性脑卒中是一种常见且具有高发病率和死亡率的严重疾病。尽管使用动物模型进行了广泛的研究，但在理解人类脑卒中的病理过程方面仍存在很大差距。我们之前开发了一个组织库，用于分析接受机械血栓切除术的患者颅内血栓近端和远端的血液（ClinicalTrials.gov 标识符，NCT03153683）。本研究的目的是评估卒中期间血气变化和酸碱平衡，并确定血管侧支循环如何影响这些变化。
我们分析了 BACTRAC（血栓切除术注册和协作研究）注册研究中前 62 例患者的血液样本和计算机断层血管造影侧支评分。分析了颅内（远端）和全身（近端）动脉血相对于闭塞性血栓的碳酸氢盐、氧分压和二氧化碳分压（pCO）值。还分析了全身和颅内血气值的组间差异。
血栓切除术中，全身血液的氧分压、pCO 和碳酸氢盐水平均明显高于颅内血液（均 P < 0.001）。侧支循环对远端血气值没有显著影响。与女性患者相比，男性患者的全身 pCO 值更高（39.8 对 36.6 mmHg；P = 0.0065），全身和颅内 pH 值更低（7.351 对 7.392；P = 0.0047）。
大动脉闭塞性脑卒中患者血栓近端和远端的动脉血气不同。尽管血管侧支循环似乎没有影响血气变化，但男女之间的一些血气值存在差异。碳酸氢盐和 pCO 的变化提示在梗死发生时存在代偿性酸碱过程。
