Multichannel near-infrared spectroscopy as a tool for assisting intra-arterial fasudil therapy for diffuse vasospasm after subarachnoid hemorrhage.
Multichannel near-infrared spectroscopy as a tool for assisting intra-arterial fasudil therapy for diffuse vasospasm after subarachnoid hemorrhage.
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DOI：
10.4103/2152-7806.81728
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发表时间：
2011
影响因子：
--
通讯作者：
Ishikawa T
中科院分区：
文献类型：
--
作者：
Mutoh T;Kobayashi S;Tamakawa N;Ishikawa T
动脉瘤性蛛网膜下腔出血（SAH）后难以接受药物治疗的弥漫性脑血管痉挛可以通过动脉内给予血管扩张剂来治疗，但用于诊断和治疗评估的有效床边监测很少。我们展示了多通道近红外光谱 (NIRS) 局部脑氧饱和度 (rSO2) 监测的成功应用，协助对远端血管区域患有 SAH 后血管痉挛的患者动脉内注射盐酸法舒地尔。一名 63 岁男性因右侧大脑中动脉动脉瘤破裂而出现 SAH 和脑内血肿，在 SAH 发病后第 9 天出现失语和右侧无力。怀疑迟发性脑缺血归因于左大脑前动脉和大脑中动脉远端区域的弥漫性血管痉挛。由于尽管使用多巴酚丁胺进行最大程度的高动力治疗，但症状仍然存在，因此随后在 rSO2 监测（包括使用四通道柔性 NIRS 传感器监测受痉挛影响的血管区域）的情况下进行动脉内法舒地尔治疗。动脉内输注法舒地尔后，血管造影记录的血管痉挛区域的 rSO2 降低且波动，随着血管痉挛的缓解而立即升高，而血管痉挛的缓解与神经功能的改善相关。第 11 天重复该过程，因为效果是短暂的，并且神经功能恶化和 rSO2 减少再次出现。动脉内注射法舒地尔后，缺陷随着 rSO 2 的摄取和维持而得到解决，从而产生良好的功能结果。使用多通道 NIRS 进行连续 rSO2 监测是辅助动脉内法舒地尔治疗检测和治疗暴露于弥漫性血管痉挛的局灶性缺血区域的可行策略。
Diffuse cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) refractory to medical management can be treated with intra-arterial administration of vasodilators, but valid bedside monitoring for the diagnosis and therapeutic assessment is poorly available. We demonstrate the successful application of regional cerebral oxygen saturation (rSO2) monitoring with multichannel near-infrared spectroscopy (NIRS) in assisting intra-arterial infusions of fasudil hydrochloride to a patient suffering from post-SAH vasospasm in the distal vascular territories. A 63-year-old man presented with SAH and intracerebral hematoma due to ruptured right middle cerebral artery aneurysm developed aphasia and right-sided weakness on day 9 after SAH onset. Delayed cerebral ischemia attributable to diffuse vasospasm in the distal territories of the left anterior and middle cerebral arteries was suspected. Since the symptoms persisted despite maximal hyperdynamic therapy with dobutamine, intra-arterial fasudil treatment in the setting of rSO2 monitoring including the spasm-affected vascular territory with four-channel flexible NIRS sensors was subsequently performed. Decreased and fluctuating rSO2 in angiographically documented vasospastic territories increased immediately after intra-arterial fasudil infusion in accordance with relief of vasospasm that correlated with neurological improvement. The procedure was repeated on day 11 since the effect was transient and neurological deterioration and reduction of rSO2 recurred. The deficits resolved accompanied by uptake and maintenance of rSO 2 following the intra-arterial fasudil, resulting in favorable functional outcome. Continuous rSO2 monitoring with multichannel NIRS is a feasible strategy to assist intraarterial fasudil therapy for detecting and treating the focal ischemic area exposed to diffuse vasospasm.