Bowler J V, Wade J P, Jones B E, Nijran K S, Steiner T J
Department of Clinical Neuroscience, Charing Cross and Westminster Medical School, London, UK.
J Neurol Neurosurg Psychiatry. 1998 Jan;64(1):90-7. doi: 10.1136/jnnp.64.1.90.
Little is known about the effect of spontaneous reperfusion of human cerebral infarcts. Single photon emission computerised tomography (SPECT) data were analysed from a study using 99Tc(m) HMPAO (99Tc(m) hexamethylpropyleneamine oxime) in human cerebral infarction for the frequency of reperfusion and to see if it affected infarct size, oedema, haemorrhagic transformation, or functional outcome.
Fifty sequential cases of ischaemic stroke were studied with 124 99Tc(m) HMPAO SPECT at around one day, one week, and three months after stroke along with detailed clinical and functional assessments.
Visually apparent reperfusion occurred in 14 of 50 patients (28%) with a mean delay of 5.8 days and reperfusion was seen in seven others in whom it was identified on the basis of changes in perfusion deficit volume. It occurred in 13 of 23 embolic events but only in three of 23 other events. In only two cases did spontaneous reperfusion occur early enough to preserve tissue or function. Reperfusion did not otherwise reduce infarct size, or improve clinical or functional outcome, and was not associated with oedema but an association with haemorrhagic transformation was suggested. Reperfusion significantly decreased the apparent perfusion defect as measured by SPECT one week from the ictus, but was mostly non-nutritional and transient. The mean volume of tissue preserved by nutritional reperfusion was 10 cm3, but this was unequally distributed between cases. Late washout of 99Tc(m) HMPAO from areas of hyperaemic reperfusion may be a good prognostic marker but is a rare phenomenon and too insensitive to be of general applicability.
Spontaneous reperfusion after cerebral infarction occurs in 42% of cases within the first week but is associated with clinical improvement in only 2%. It has few adverse consequences although it may be associated with haemorrhagic transformation.
关于人类脑梗死自发再灌注的影响，目前所知甚少。对一项使用99锝（m）六甲基丙烯胺肟（99Tc（m）HMPAO）研究人类脑梗死的单光子发射计算机断层扫描（SPECT）数据进行分析，以了解再灌注的频率，并观察其是否会影响梗死灶大小、水肿、出血性转化或功能结局。
对50例连续的缺血性卒中病例进行研究，在卒中后约1天、1周和3个月时进行124次99Tc（m）HMPAO SPECT检查，并进行详细的临床和功能评估。
50例患者中有14例（28%）出现肉眼可见的再灌注，平均延迟时间为5.8天，另外7例根据灌注缺损体积的变化确定有再灌注。在23例栓塞事件中有13例出现再灌注，但在其他23例事件中仅3例出现。只有2例自发再灌注发生得足够早，能够保留组织或功能。否则，再灌注并不会缩小梗死灶大小，也不会改善临床或功能结局，且与水肿无关，但提示与出血性转化有关。从发病起1周时，SPECT测量显示再灌注显著降低了明显的灌注缺损，但大多是非营养性的且是短暂的。营养性再灌注保留的组织平均体积为10立方厘米，但各病例之间分布不均。99Tc（m）HMPAO从充血性再灌注区域的晚期洗脱可能是一个良好的预后标志物，但这是一种罕见现象，且过于不敏感，无法普遍适用。
脑梗死发生后，42%的病例在第一周内出现自发再灌注，但仅2%与临床改善相关。尽管可能与出血性转化有关，但不良后果较少。
