在莫亚莫亚病的直接重血管化过程中代谢变化:说明案例
Fuat Arikan1,2, Ivette Chocron3, Helena Calvo-Rubio1
11Department of Neurosurgery and.
Journal of neurosurgery. Case lessons
|July 3, 2023
概括
使用微透析和大脑组织氧气探针进行手术内监测,可以在莫亚莫亚病绕道手术期间评估大脑血液动力学. 这种技术证实了大脑新陈代谢和氧化的改善,降低了重血管化后中风风险.
科学领域:
- 神经外科 神经外科
- 脑血管外科 脑血管外科
- 神经学 神经学
背景情况:
- 莫亚莫亚病 (MMD) 需要对脑输液受损和缺血事件的患者进行脑血管再循环.
- 标准治疗包括低流量绕道,有或没有间接的再血管.
- 在MMD诱导的缺血期间进行外科手术期间的代谢监测并未得到充分描述.
研究的目的:
- 描述手术内微透析和脑组织氧气局部压力 (PbtO2) 监测在莫亚莫亚病患者的直接再血管化期间的实用性.
- 为了说明对手术干预的反应中的代谢和血液动力学变化.
主要方法:
- 使用手术内微透析来测量大脑组织分析物 (葡萄糖,乳酸盐,酸盐,糖醇).
- 使用脑组织氧气部分压力 (PbtO2) 探针进行实时氧化评估.
- 监测PbtO2:PaO2比率和乳酸:pyruvate比率以评估组织缺氧和无氧代谢.
主要成果:
- 绕道前:严重的组织缺氧表明PbtO2:PaO2比率<0.1和无氧代谢 (乳酸盐:酸盐比率>40).
- 绕道后:PbtO2的快速和持续增加 (PbtO2:PaO2比率为0.1-0.35) 和大脑新陈代谢的正常化 (乳酸盐:酸盐比率<20).
结论:
- 在莫亚莫亚病患者中,直接解剖迅速改善区域大脑血液动力学.
- 在手术期间的监测有效地证明了重血管化的好处,可能会降低手术后的缺血性中风的发生率.
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