Comparison of induced hypertension, fluid bolus, and blood transfusion to augment cerebral oxygen delivery after subarachnoid hemorrhage Clinical article
Comparison of induced hypertension, fluid bolus, and blood transfusion to augment cerebral oxygen delivery after subarachnoid hemorrhage Clinical article
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DOI：
10.3171/2011.9.jns11691
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发表时间：
2012-03-01
影响因子：
4.1
通讯作者：
Diringer, Michael N.
中科院分区：
文献类型：
--
作者：
Dhar, Rajat;Scalfani, Michael T.;Diringer, Michael N.
物体。蛛网膜下腔出血(SAH)后迟发性脑缺血(DCI)的发生与氧输送(DO2)的严重减少有关。如果DO2不能及时恢复，则可能导致不可逆转的损伤(即脑梗塞)。DCI(即诱发性高血压和高容量血症)的血流动力学治疗旨在通过增加脑血流量(CBF)来改善DO2。输注红细胞(RBC)可能是一种替代策略，通过改善动脉血氧含量来增加DO2。作者比较了这三种干预措施改善大脑DO2的相对能力，特别是它们将DO2恢复到受损区域的能力。作者比较了3项前瞻性生理学研究，其中使用PET成像测量了以下治疗前后的整体和局部CBF和DO2：1)静脉推注15ml/kg生理盐水(9例)；2)平均动脉压升高25%(12例)；3)在38例有DCI风险的动脉瘤性SAH患者中输注1U红细胞(17例)。低DO2地区群体之间的反应(
Object. Critical reductions in oxygen delivery (DO2) underlie the development of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). If DO2 is not promptly restored, then irreversible injury (that is, cerebral infarction) may result. Hemodynamic therapies for DCI (that is, induced hypertension [IH] and hypervolemia) aim to improve DO2 by raising cerebral blood flow (CBF). Red blood cell (RBC) transfusion may be an alternate strategy that augments DO2 by improving arterial O-2 content. The authors compared the relative ability of these 3 interventions to improve cerebral DO2, specifically their ability to restore DO2 to regions where it is impaired.Methods. The authors compared 3 prospective physiological studies in which PET imaging was used to measure global and regional CBF and DO2 before and after the following treatments: 1) fluid bolus of 15 ml/kg normal saline (9 patients); 2) raising mean arterial pressure 25% (12 patients); and 3) transfusing 1 U of RBCs (17 patients) in 38 individuals with aneurysmal SAH at risk for DCI. Response between groups in regions with low DO2 (