Rhodes R S, Spetzler R F, Roski R A
Surgery. 1981 Aug;90(2):433-8.
This study, by use of direct measurement, sought to investigate the role of diminished cerebral blood flow on neurologic function after cerebrovascular accident (CVA). Twenty-seven patients had mean middle cerebral artery pressure (MCAP) measured intraoperatively prior to a superficial temporal artery to middle cerebral artery bypass. The ratio of MCAP to mean systemic blood pressure (BP) was less than 0.500 in 11 patients. Six of these 11 had preoperative neurologic deficit and four of these six had improved neurologic function after revascularization. In 16 patients the MCAP/BP was greater than 0.500, and none of the seven patients with neurologic deficit improved postoperatively. In general, the MCAP/BP correlated well with the angiographic severity of cerebrovascular disease. In 16 patients, unsuitable for conventional bypass, autogenous saphenous vein was used as a bypass from the subclavian or other extracranial artery to a cortical branch of the middle cerebral artery. One cerebral death and one CVA occurred postoperatively early in the series, but there have been no untoward events since deep barbituate anesthesia has been used. Diminished cerebral blood flow after CVA may leave a pool of viable but nonfunctional neurons. Extracranial-intracranial bypass may improve neurologic function in such patients.
本研究通过直接测量，试图探讨脑血管意外（CVA）后脑血流量减少对神经功能的作用。27例患者在进行颞浅动脉至大脑中动脉搭桥手术前术中测量了大脑中动脉平均压（MCAP）。11例患者的MCAP与平均体循环血压（BP）之比小于0.500。这11例患者中有6例术前存在神经功能缺损，其中4例在血运重建后神经功能得到改善。16例患者的MCAP/BP大于0.500，7例有神经功能缺损的患者术后均无改善。一般来说，MCAP/BP与脑血管疾病的血管造影严重程度密切相关。16例不适于传统搭桥手术的患者，采用自体大隐静脉从锁骨下动脉或其他颅外动脉搭桥至大脑中动脉的皮质分支。该系列手术早期术后发生1例脑死亡和1例CVA，但自从使用深度巴比妥类麻醉后未再出现不良事件。CVA后脑血流量减少可能会留下一群存活但无功能的神经元。颅外-颅内搭桥术可能会改善这类患者的神经功能。
