急性卒中患者甘露醇治疗前后的脑血流变化

Changes of cerebral blood flow pre-and post-treatment with mannitol in patients with acute stroke

目的探讨急性卒中患者在脑水肿高峰期应用不同剂量甘露醇后脑血流的变化。方法对28例大脑半球卒中患者行20%甘露醇静脉滴注脱水降颅压治疗,剂量为125ml或250ml。应用经颅多普勒监测用药前后两侧大脑中动脉血流,监测参数包括收缩期峰值血流速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)、搏动指数(PI)及各参数变化的百分率(PR),同时监测肱动脉血压。结果滴注125ml甘露醇患者病变侧与非病变侧Vs、Vd、Vm均有明显改善,病变侧PI在45～60min时下降明显(与输注前比较,45min时,P=0．002；65min时,P= 0．028),非病变侧PI下降差异无显著性(P＞0．05),两侧Vs、Vd、Vm、PI的PR差异无显著性,同时双侧脑血流速度改善和PI下降稳定而持续；滴注250ml甘露醇患者病变侧与非病变侧Vs、Vd、Vm呈波动性改善,病变侧PI下降不明显(P＞0．05),非病变侧PI在60min时下降显著(P=0．005),60min时两侧PI的PR差异有显著性(P=0．006)。滴注125ml或250ml甘露醇患者的病变侧血流速度改善和PI降低的高峰时间均较非病变侧延迟。结论滴注125ml甘露醇卒中患者的病变侧脑血流动力学改善程度好于非病变侧,而滴注250ml甘露醇非病变侧的脑血流动力学改善程度好于病变侧。

Objective To find out the relationship between the use of different dosages of mannitol and the changes of cerebral blood flow in patients with stroke at the peak of edema formation, methods Twentyeight patients with hemispheric stroke were treated with 20% mannitol solution for reduction of increased intracranial pressure, at the dosages of 125 ml or 250 ml. Transcranial Doppler was used to monitor the blood flow of the bilateral middle cerebral arteries before and after the treatment. The monitoring parameters included peak systolic velocity （ Vs）, end diastolic velocity （ Vd）, mean velocity （ Vm）, and pulsatility index （ PI）, and percentage rate （PR） of change in each parameter. At the same time, the blood pressure of brachial artery was monitored. Results Vs, Vd, and Vm on the affected and unaffected sides were improved significantly in patients using 125 ml mannitol. The PI on the affected sides decreased markedly （ P = 0. 002, P = 0. 028 ） from 45 min to 60 min ; the PI on the unaffected sides did not decrease significantly （P 〉 0. 05 ） ; there were no significant differences in the PR of Vs, Vd, Vm and PI on both sides （P 〉 0. 05）. Vs, Vd, and Vm on the affected and unaffected sides were improved fluctuatly in patients using 250 ml mannitol. The PI on the affected sides did not decrease markedly （ P 〉 0. 05 ） ; the PI on the unaffected sides decreased significantly （P = 0. 005 ） 60 min after mannitol infusion ; the PR of PI at 60 rain had significant difference between two sides （P = 0. 006）. The peaks of the velocity of blood flow increasing and PI decreasing on the affected sides occured later than that on the unaffected sides in patients both using 125 ml and 250 ml mannitol. Conclusion The improvement of cerebral hemedynamies on the affected sides is more significant than that on the unaffected sides with 125 ml mannitol, and the improvement of cerebral hemodynamics on the unaffected sides is more significant than that on the affected sides with 250 ml mannitol.