Venous stump pressure and brain damage after corticol vein occulusion

采用犬皮质静脉阻塞模型，评价监测静脉残端压力能否预测静脉阻塞后脑梗塞的发生。在双侧矢状旁开颅术中，在临时闭塞期间直接测量每侧大脑皮质静脉内的压力增加。永久性静脉阻塞后24小时脑实质损害分为：0期：无脑实质损害；I期：轻度水肿期；II期：中度脑实质水肿和/或神经元性缺血性改变；III期：中度至重度出血。组织学分期与静脉压升高密切相关：0级(12例)平均血压升高5.5(SY+-2.9)mm Hg，I期(5例)7.7(SY+-)3.2 mm Hg，II期(5例)11.2(SY+-[)4.1 mm Hg，III期(7例)16.4(SY+-5.0)mm Hg。0期与II期(P&lt；0.001)、0期与III期(P&lt；0.01)之间有显著差异。伊文思蓝渗出表明血脑屏障的破坏与压力升高有很好的相关性。这些结果可能预示着皮质静脉阻塞后的损伤阈值。在测试闭塞期间测量静脉残端压力可能是预测脑损伤的有用辅助手段，并有助于术中选择静脉切除。

A canine model of cortical vein occlusion was used to evaluate whether monitoring the venous stump pressure could predict cerebral infarction after venous obstruction. Under bilateral parasagittal craniotomy, an increase in the pressure within the cortical vein in each hemisphere was directrly measured during temporary occlusion. Brain parenchymal damage 24 hours after subsequent permanent venous obstruction was classified as : stage 0 : no parenchymal damage ; stage I : mild edema ; stage II : moderate parenchymal edema and/or ischemic changes in neurous, stage III : moderate to severe hemorrhage. Histological stages correlated closely with the rise in venous pressure : mean pressure increases were 5.5(]SY+-[)2.9 mmHg in hemispheres graded as stage 0 (n=12), 7.7(]SY+-[)3.2mmHg those graded in stage I (n=5), 11.2(]SY+-[)4.1 mmHg in those classed as stage II (n=5), and 16.4(]SY+-[)5.0 in those categorized as stage III (n=7). There were significant differences between stage 0 and stage II (p<0.01), and stage 0 and stage III (p<0.001). Disruption of the blood-brain barrier as indicated by Evans blue dye extravasation correlated well with the pressure increment. These results may indicate the threshold for injury after cortical venous occlustion. Venous stump pressure measurements during a test occlusion may be a useful adjunct in predicting brain damage and be helpful for intraoperative selection for venous resection.