胶体溶液对动脉瘤性蛛网膜下腔出血后脑血管痉挛患者脑血流量的影响

Effect of colloidal solution on cerebral blood flow in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage

目的探讨静脉输注胶体溶液扩容对动脉瘤性蛛网膜下腔出血后,脑血管痉挛患者缺血脑组织脑血流的影响。方法经DSA确诊为动脉瘤性蛛网膜下腔出血患者30例,根据是否出现脑血管痉挛分为脑血管痉挛组(12例)和无痉挛组(18例)。应用氙(Xe)-CT评价双侧大脑前动脉、大脑中动脉和大脑后动脉的局部脑血流量(rCBF)后,对脑血管痉挛组患者在30 min内经静脉注入胶体溶液——琥珀酰明胶(4 ml/kg),再次进行Xe-CT检查,比较扩容前后的rCBF变化。记录输液前后的血压、心率、中心静脉压的变化。结果①无痉挛组患者双侧大脑前动脉、大脑中动脉和大脑后动脉的rCBF均>30 ml.100 g-1.min-1。脑血管痉挛组患者(共72支血管供血区)至少1支血管供血区的rCBF<30 ml.100 g-1.min-1,其中7支血管供血区的rCBF≤25 ml.100 g-1.min-1。②扩容前后,脑血管痉挛组患者的收缩压、舒张压、平均动脉压和中心静脉压变化差异均无统计学意义,均P>0.05。③rCBF>25 ml.100 g-1.min-1的65支血管,扩容前后的rCBF比较,差异无统计学意义;rCBF≤25 ml.100 g-1.min-1的7支血管,rCBF由(20±3)ml.100 g-1.min-1升高为(34±6)ml.100 g-1.min-1,差异有统计学意义,P<0.01。④术后1年随访,两组患者的格拉斯哥预后评分比较,差异无统计学意义。结论胶体溶液扩容后,可以升高脑血管痉挛患者的缺血区域的rCBF,可能有助于改善患者的预后。

Objective To investigate the effect of colloidal solution infusion on cerebral blood flow in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Methods Thirty patients diagnosed as aneurysmal subarachnoid hemorrhage with digital subtraction angiography （DSA） were divided into a vasospasm group （n = 12） and a control group （n = 18） according to whether they had cerebral vaso- spasm or not. After evaluating the regional cerebral blood flow （rCBF） of the bilateral anterior cerebral ar-tery, middle cerebral artery and posterior cerebral artery with Xe-CT, the colloidal solution （succinylated gelatin, 4 mL/kg） was injected intravenously in the patients of the vasospasm group within 30 minutes. Xe-CT was performed again, and the changes of rCBF before and after the colloidal solution expansion were compared. The changes of blood pressure, heart rate, and central venous pressure before and after infusion were documented. Results ①The rCBF of bilateral anterior cerebral artery, middle cerebral artery and pos-terior cerebral artery was more than 30 mL · 100 g^-1.min^-1 the control group. The rCBF was lower than 30 mL · 100 g^-1.min^-1at least in 1 blood supplied region in the vasospasm group （72 blood supply regions al- together）, in which CBF were lower than 25 mL · 100 g^-1.min^-1 in 7 blood supplied regions. ②Before and af-ter the expansion, there were no significant differences among the systolic and diastolic blood pressure, mean ar-terial pressure, and central venous pressure in the vasospasm group （P 〉 0. 05 ）. ③Of the 65 vessels with rCBF 〉25 mL · 100 g^-1.min^-1 there were no significant differences in rCBF before and after the expansion （P = 0. 272） ; of the 7 vessels with rCBF ≤ 25 mL · 100 g^-1.min^-1, the rCBF increased from 20 ±3 mL · 100 g^-1.min^-1to 34 -＋6 mL · 100 g^-1.min^-1. There were significant differences （P 〈0. 01 ）. ④One year follow-up after the procedure, there was no significant difference in GOS score between the 2 groups. Conclusion Col-loidal solution expansion may increase the rCBF of the ischemic regions in patients with cerebral vasospasm and help to improve the prognosis of the patients.