Cerebral Autoregulation and CO2 Reactivity Before and After Elective Supratentorial Tumor Resection
Cerebral Autoregulation and CO2 Reactivity Before and After Elective Supratentorial Tumor Resection
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DOI：
10.1097/ana.0b013e3181c9fbf1
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发表时间：
2010-04-01
影响因子：
3.7
通讯作者：
Vavilala, Monica S.
中科院分区：
文献类型：
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作者：
Sharma, Deepak;Bithal, Parmod K.;Vavilala, Monica S.
背景：肿瘤手术减压对自身调节和 CO2 反应性的影响尚不清楚。我们检查了选择性肿瘤切除术对脑自动调节和 CO2 反应性的影响。方法：在标准麻醉下接受选择性开颅手术切除肿瘤的幕上肿瘤患者在术前即刻以及术后 6 至 24 小时内进行脑自动调节和 CO2 反应性测试。采用同侧颈总动脉压迫10秒后大脑中动脉短暂充血反应，计算短暂充血反应比（THRR）。 THRR > 1.1 定义为正常的自动调节。滴定自愿过度换气以使 ETCO2 降低至基线以下 10 mm Hg，并计算 CO2 反应性。结果：对 35 名患者（26 名男性和 9 名女性）进行了研究。总体而言，该队列的肿瘤切除前后脑自动调节完好无损（THRR 1.27 +/- 0.10 和 1.30 +/- 0.12，P = 0.11）。然而，7 名 (20%) 患者术前脑自动调节功能受损，并且肿瘤切除后所有 7 名患者的脑自动调节功能仍然受损。较大的肿瘤尺寸（P = 0.002）和中线移位超过 5 mm（P < 0.001）与大脑自动调节受损相关。二十八名（80%）术前大脑自动调节功能完好的患者术后仍保持自动调节。所有患者手术前后的 CO2 反应性均在正常范围内，并且在 2 个周期之间没有变化（3.41 +/- 0.46/mm Hg 和 3.60 +/- 0.63%/mm Hg，P = 0.07）。结论：大量幕上肿瘤尺寸较大且中线移位超过 5mm 的患者术前大脑自动调节受损，并且与术前脑自动调节功能相关。
Background: The effect of surgical decompression of tumor on autoregulation and CO2 reactivity is not known. We examined the effect of elective tumor resection on cerebral autoregulation and CO2 reactivity.Methods: Patients with supratentorial tumors undergoing elective craniotomy for tumor resection under standard anesthesia underwent cerebral autoregulation and CO2 reactivity testing immediately before and between 6 and 24 hours after surgery. Transient hyperemic response of the middle cerebral artery after the release of 10 second compression of the ipsilateral common carotid artery was used to calculate the transient hyperemic response ratio (THRR). THRR > 1.1 defined the normal autoregulation. Voluntary hyperventilation was titrated to reduce the ETCO2 by 10 mm Hg below baseline and CO2 reactivity was calculated.Results: Thirty-five patients (26 male and 9 female) were studied. Overall, cerebral autoregulation was intact before and after tumor resection for the cohort (THRR 1.27 +/- 0.10 and 1.30 +/- 0.12, P = 0.11). However, cerebral autoregulation was impaired preoperatively in 7 (20%) patients and remained impaired in all 7 patients after tumor resection. Larger tumor size (P = 0.002), and midline shift more than 5 mm (P < 0.001) were associated with impaired cerebral autoregulation. Twenty-eight (80%) patients who had intact preoperative cerebral autoregulation maintained autoregulation postoperatively. CO2 reactivity was within normal limits before and after surgery in all patients and did not change between the 2 periods (3.41 +/- 0.46/mm Hg and 3.60 +/- 0.63%/mm Hg, P = 0.07).Conclusion: Preoperative cerebral autoregulation was impaired in a significant number of patients with large supratentorial tumor size and midline shift more than 5mm and was associated