氙CT定量脑血流测定结合乙酰唑胺负荷试验在缺血性脑血管病血流重建手术中的应用

The application of hemodynamic evaluation with xenon CT and acetazolamide challenge test in procedures in patients with ischemic cerebral vascular diseases

目的探讨氙CT结合乙酰唑胺负荷试验脑血流动力学评价在缺血性脑血管病血流重建手术中的应用。方法回顾性分析25例慢性缺血性脑血管病患者临床资料，患者均行颞浅动脉一大脑中动脉吻合术，并有完整的术前、术后氙CT结合乙酰唑胺负荷试验进行脑血流量测定及脑血管储备功能评价的临床资料以及术后随访资料。结果术前25例患者静息状态下患侧局部脑血流量〈40ml·100g^-1·min^-1，较对侧明显降低（P〈0．001）；患侧血管扩张能力〈30％，低于健侧（P〈0．001）。术后25例患者吻合口全部通畅，静息状态下患侧局部脑血流量较术前明显增加（P〈0．001），17例患者脑血管储备功能恢复正常。结论氙CT结合乙酰唑胺负荷试验显示局部脑血流量轻度下降及脑血管储备功能不足者可能从血流重建手术中获益。

Objective To evaluate the hemodynamics of revascularization with xenon CT and acetazolamide challenge test in patients with ischemic cerebral vascular diseases. Methods 25 patients with chronic ischemic cerebral vascular diseases were analyzed retrospectively. In these patients, Xenon CT and acetazolamide challenge test were used to measure the regional cerebral blood flow and evaluate the cerebral vascular reserving function preoperatively. Superficial temporal artery - middle cerebral artery anastomosis was preformed in all patients. The pateucy of the anastomosis was verified using DSA. The changes of regional cerebral blood flow were assessed by Xeon CT and the patients were all followed up in outpatient department to record the clinical manifestations postoperatively. Results The static regional cerebral blood flow in ischemic areas in 25 patients were less than 40ml·100g^-1·min^-1which was less than that of the contralateral side （ P 〈 0. 001 ）. Acetazolamide challenge test showed that the vascular dilation capacity （VDC） of ischemic areas was less than 30% which was also less than that of the contralateral side （ P 〈0. 001 ）. All the 25 anastomoses were patent. The duration of follow up was 2 - 18 months. The ischemic symptoms were relieved in 21 patients. But 2 patients showed no improvement and 2 patients were lost within the follow - up duration. The rCBF in the affected region was increased significantly by the detection of postoperative xenon CT （ P 〈 0. 001 ）. Except 8 patients, the cerebral vascular reserving functions were restored. Conclusion In the patients with TIA or RIND whose rCBF were less than 40ml·100g^-1·min^-1 and who demonstrated decreased cerebral vascular reserving function perhaps would benefit from revaseularization. But the indication of revascularization of the patients with stroke needed to be evaluated by more large -scale prospective studies.