Effects of repeated temporary clipping of the middle cerebral artery on pial arterial diameter, regional cerebral blood flow, and brain structure in cats.
Effects of repeated temporary clipping of the middle cerebral artery on pial arterial diameter, regional cerebral blood flow, and brain structure in cats.
复制标题
反复临时夹闭大脑中动脉对猫的软脑膜动脉直径、局部脑血流量和大脑结构的影响。
DOI：
10.1227/00006123-199012000-00009
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发表时间：
1990
期刊：
影响因子：
4.8
通讯作者：
Y. Sasaoka
中科院分区：
文献类型：
--
作者：
T. Sakaki;S. Tsunoda;T. Morimoto;T. Ishida;Y. Sasaoka
临时夹闭主要动脉干是神经外科手术中控制意外出血的重要策略;然而，反复临时夹闭可引起术后严重的神经功能缺损。本研究旨在证实和解释这些临床结果。最初，对5只猫中的每只进行单次大脑中动脉闭塞20分钟或1小时。采用影像学方法测量软脑膜动脉直径，放射自显影法测量局部脑血流量，观察脑水肿和梗死情况。20分钟阻断组再灌注后5小时未见异常改变。在1小时闭塞组中，软脑膜动脉扩张了45%，局部脑血流量增加到静息皮质值的两倍以上。脑水肿的范围为41.2 ± 7.5%（SE），梗死为34.5 ± 9.5%（SE）。在第二个实验中，在20只猫中进行了3次20分钟的大脑中动脉闭塞，间隔1小时。其中10例使用硫喷妥钠（40 mg/kg）进行脑保护。在未接受巴比妥类药物治疗的组中，实验结束时软脑膜动脉扩张40%，与单次20分钟闭塞相比，局部脑血流量下降至约70%，脑水肿为19.5 ± 8.1%（SE），半球梗死为8.1 ± 3.7%（SE）。在治疗组中，这些只是微不足道的变化。反复夹闭的影响可能累积导致脑损伤，需要反复夹闭时应使用巴比妥类药物。
Temporary clipping of the major arterial trunk is an important maneuver to control excessive unexpected bleeding in neurosurgical operations; however, repeated temporary clipping can give rise to severe neurological deficits after surgery. The present study was performed to confirm and explain these clinical findings. Initially, a single 20-minute or 1-hour occlusion of the middle cerebral artery was performed in each of 5 cats. Pial arterial diameter was determined by video imaging, regional cerebral blood flow was measured by autoradiography, and cerebral edema and infarction were observed. In the 20-minute occlusion group, no abnormal changes were found 5 hours after recirculation. In the 1-hour occlusion group, pial arteries were dilated by 45%, and regional cerebral blood flow increased to more than twice the resting cortical values. The extent of cerebral edema was 41.2 +/- 7.5% (SE) and infarction was 34.5 +/- 9.5% (SE) of the hemisphere. In the second experiment, three 20-minute occlusions of the middle cerebral artery in a 1-hour interval were performed in 20 cats. In 10 of them, thiopental (40 mg/kg) was used to protect the brain. In the group without barbiturate treatment, pial arteries were dilated by 40% at the end of experiment, regional cerebral blood flow decreased to about 70% compared with single 20-minute occlusion, cerebral edema was 19.5 +/- 8.1% (SE), and infarction was 8.1 +/- 3.7% (SE) of the hemisphere. In the treated group, these were only trivial changes. The effect of repeated clipping may cumulatively cause brain damage, and barbiturates should be used whenever repeated clipping is necessary.