Wood J H, Polyzoidis K S, Kee D B, Prats A R, Gibby G L, Tindall G T
Neurosurgery. 1984 Oct;15(4):535-9. doi: 10.1227/00006123-198410000-00011.
Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation. Therefore, hemodilution was initiated in an effort to increase cerebral perfusion during this marginal period when the STA was beginning to dilate progressively. Incremental venesections with equal intravenous volume replacement with 5% human serum albumin caused a significant lowering of the hematocrit from 40 +/- 1 to 33 +/- 1%. This isovolemic hemodilutional therapy resulted in significant mean regional cerebral blood flow (rCBF) elevations of 23 +/- 5% (SE) in the bypassed MCA territory and of 25 +/- 6% in the opposite MCA region. The mean gray flow (F1) in the involved and homologous MCA regions significantly increased 27 +/- 8% and 30 +/- 11%, respectively. Similarly, the initial slope index (ISI2) significantly rose by 17 +/- 5% in the bypassed MCA territory and by 18 +/- 6% in the homologous region. These data objectively support the premise that reductions in hematocrit without intravascular volume expansion augment cerebral blood flow, probably by reducing blood viscosity.(ABSTRACT TRUNCATED AT 250 WORDS)
实验性血液稀释疗法已被证明可提高向颈内动脉（ICA）和大脑中动脉（MCA）闭塞远端急性缺血性脑区的侧支灌注，并缩小梗死面积。颞浅动脉（STA）-MCA吻合术通过手术建立额外的区域侧支循环，并且随着时间的推移，这种搭桥血管造影显示会扩大。尽管通过颅骨切除术边缘的多普勒记录验证了搭桥通畅，但11例中风患者的显微外科STA-MCA吻合术并未使通过133氙吸入测定的任何一个半球MCA区域的脑灌注参数出现早期变化。因此，在STA开始逐渐扩张的这个临界期，开始进行血液稀释以增加脑灌注。等量静脉输注5%人血清白蛋白以替代逐渐放出的静脉血，导致血细胞比容从40±1%显著降至33±1%。这种等容血液稀释疗法使搭桥的MCA区域平均局部脑血流量（rCBF）显著升高23±5%（标准误），对侧MCA区域升高25±6%。受累及同源MCA区域的平均灰质血流量（F1）分别显著增加27±8%和30±11%。同样，初始斜率指数（ISI2）在搭桥的MCA区域显著升高17±5%，在同源区域升高18±6%。这些数据客观地支持了这样一个前提，即不增加血管内容量而降低血细胞比容可能通过降低血液粘度来增加脑血流量。（摘要截选至250字）
