Post operative changes of cerebral hemodynamics after unilateral internal carotid artery resection -Evaluation of cerebral blood flow by transcranial Doppler method-

单侧颈内动脉切除术后脑血流动力学变化-经颅多普勒法评价脑血流-

• 批准号: 12671649
• 负责人: NUMATA Tsutomu
• 金额: $ 2.05万
• 依托单位: CHIBA UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2000
• 资助国家: 日本
• 起止时间: 2000 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-12671649/
• 关键词: transcranial Doppler method; cerebral hemodynamics; carotid artery resection; 経頭蓋骨的超音波ドプラ法; 頚動脈切除; 経頭蓋骨的ドプラ法; 内頸動脈切除; 脳血流自動調節能

We studied dynamic cerebrovascular autoregulation in the patients who had undergone unilateral carotid artery resection using ultrasonic transcranial Doppler method (TCD). The correlation between the flow velocity of the middle cerebral artery (FV_<MCA>) and the cerebral perfusion pressure (CPP) was investigated. CPP was calculated from the systemic arterial blood pressuure adjusted to the level of MCA (ABP_<MCA>) and the critical closing pressure (CCP), which was estimated from the systolic-diastolic relationship between FV_<MCA> and ABP_<MCA>. CCP demonstrates the arterial pressure below which blood flow stops within the MCA. Initially we studied dynamic cerebrovascular responses in eight healthy humans during repetitive stepwise upward tilt and downward tilt. The results of the study indicated that FV_<MCA> was changed in accordance with the changes of CPP, which was changed in accordance to the change of CCP. Next we studied post-operative changes of cerebral hemodynamics after unilateral internal carotid artery resection in four patients. FV_<MCA> recovered within 1-2 days after internal carotid artery resection. CPP was raised not because ABP_<MCA> elevated but CCP was markedly lowered in 1-2 days, after surgery. Interception of internal jugular/vein of these patients elevated CCP and lowerd FV_<MCA> resticting the dynamic cerebrovascular autoregulation of patients with unilateral carotid artery resection within a small range. From the results of this reserch, FV_<MCA> was maintained mainly by lowered CCP in patients with carotid artery resection. Reconstruction of artery which raise ABP_<MCA> and reconstruction of internal jugular vein which lowers CCP will improve the cerebral blood flow in those patients with insufficient dynamic cerebrovascular autoregulation.

应用超声经颅多普勒法(TCD)对单侧颈动脉切除术后患者的动态脑血管自动调节功能进行了研究。研究大脑中动脉血流速度(Fv&lt；Mca&gt；)与脑灌流压(CPP)的相关性。CPP由调整到MCA水平的体动脉压(ABP&lt；MCA&gt；)和临界关闭压(Ccp)计算，临界关闭压由Fv&lt；MCA&gt；与ABP&lt；MCA&gt；之间的收缩-舒张期关系估计。CCP显示大脑中动脉内血流停止时的动脉压。最初，我们研究了8名健康人在重复、逐级向上倾斜和向下倾斜时的动态脑血管反应。研究结果表明，Fv&lt；Mca&gt；随着CPP的变化而变化，而CPP的变化又与Ccp的变化一致。接下来，我们研究了4例患者单侧颈内动脉切除术后脑血流动力学的变化。颈内动脉切除后1~2天内Fv；CPP升高不是因为术后1~2天ABP、MCA、GT升高，而是CCP明显降低。颈内静脉阻断使Ccp升高，Fv、Lt、MCA、Gt降低，抑制了小范围单侧颈动脉切除患者的动态脑血管自动调节功能。从本研究的结果来看，颈动脉切除患者的Fv_&lt；MCA&Gt；主要是通过降低CCP维持的。对于动态脑血管自动调节不足的患者，重建升主动脉、大脑中动脉和颈内静脉，降低CCP，可改善脑血流量。

项目成果

沼田勉: "内頸動脈切除と血行再建術の適応と診断法 頭頸部腫瘍外来(今野昭義編)"メジカルビュー社. 5 (2000)

沼田努：“颈内动脉切除和血运重建的指征和诊断方法，头颈肿瘤门诊（绀野昭吉编）”医学观点出版5（2000）。

Numata T, Hanazawa T, Shiba K, Nakano K, Mutou H, Nagata H, Terada N, Konno A: "Contralateral external carotid-external carotid artery bypass for vascular reconstruction in cases of common carotid artery resection."Head and Neck Cancer. 27. 607-611 (2001)

Numata T、Hanazawa T、Shiba K、Nakano K、Mutou H、Nagata H、Terada N、Konno A：“在颈总动脉切除病例中采用对侧颈外动脉-颈外动脉旁路进行血管重建。”头颈癌。

Sato J, Tachibana M, Numata T, Nishino T, Konno A: "Differences in the dynamic cerebrovascular response between stepwise up tilt and down tilt in humans"Am J Physiol Heart Circ Physiol. 281. H774-H783 (2001)

Sato J、Tachibana M、Numata T、Nishino T、Konno A：“人类逐步向上倾斜和向下倾斜之间动态脑血管反应的差异”Am J Physiol Heart Circ Physiol。

沼田勉, 柴啓介, 花沢豊行, 仲野公一, 永田博史, 寺田修久, 今野昭義: "対側外頸-外頸動脈バイパス術:総頸動脈浸潤症例における頚動脈血行再建として"頭頸部腫瘍. 27. 607-611 (2001)

Tsutomu Numata、Keisuke Shiba、Toyoyuki Hanazawa、Koichi Nakano、Hiroshi Nagata、Osamu Terada、Akiyoshi Konno：“对侧颈外动脉-颈外动脉搭桥手术：颈总动脉侵犯病例中的颈动脉血运重建”27。 607-611（2001）

Sato J, et, al.: "Differences in the dynamic cerebrovascular response between stepwise up tilt and down tilt in humans"Am J Physiol Heart Circ Physiol. 281. H774-H783 (2001)

Sato J 等人：“人类逐步向上倾斜和向下倾斜之间动态脑血管反应的差异”Am J Physiol Heart Circ Physiol。