经椎动脉常温生理盐水灌冲作为一种神经保护新疗法的可行性和安全性

Intra-vertebral artery saline infusion following digital subtraction angiography:a pilot feasibility study

目的 评估数字减影血管造影术(DSA)后经椎动脉灌冲常温生理盐水(IVNI)的可行性和安全性,为IVNI用于后循环脑梗死患者提供研究基础。方法 对接受脑动脉DSA的14例非脑卒中受试者进行IVNI(流速30~50 mL/min,持续6~10 min),期间监测受试者各项生理指标并记录患者主观症状。使用DSA或经颅多普勒超声(TCD)检测脑动脉血流速度,评估血管痉挛情况。结果 14例受试者均成功完成IVNI,其中7例(50%)受试者在IVNI期间出现短暂的头晕、头面肢体麻木无力或高血压,1例患者在IVNI后即刻的DSA中发现脑血管痉挛。IVNI后平均动脉压、心率和呼吸节律与基线相比均出现显著变化,但均在正常范围。IVNI后TCD检查发现基底动脉血流速度减慢,但未发现神经功能缺损和意识程度改变。结论 经椎动脉灌冲常温生理盐水安全可行,有望成为后循环缺血性脑卒中患者超早期神经保护的新方法。

Objective To assess the safety and feasibility of an intra-vertebral artery normothermic saline infusion(IVNI)in humans after digital subtraction angiography(DSA).Methods We performed an IVNI in 14patients following DSA which was used for observing cerebral arteries.During the IVNI,normothermic saline was perfused through the dominant vertebral artery with a velocity of 30-50 mL/min for 6-10 min.The physiological indexes of patients were monitored and their subjective feelings were recorded.The blood flow velocity and vasospasm of cerebral arteries were measured by DSA or transcranial Doppler ultrasound(TCD).Results Fourteen patients successfully completed the experiments.During the IVNI,7(50 %)patients suffered from dizziness,paresthesia,limb weakness and hypertension.After the procedure,a cerebral vascular spasm was detected in one patient.All vital signs and blood glucose were in the normal range up to 24 hours.The blood flow velocity of basilar artery was decreased,without impacting neurological functions.Conclusion The intra-arterial normothermic saline infusion through vertebral artery following DSA was safe and feasible,potentially being a new avenue for acute neuroprotection in patients with posterior circulation ischemia.