NONINVASIVE ASSESSMENT OF CO-2-INDUCED CEREBRAL VASOMOTOR RESPONSE IN NORMAL INDIVIDUALS AND PATIENTS WITH INTERNAL CAROTID-ARTERY OCCLUSIONS
NONINVASIVE ASSESSMENT OF CO-2-INDUCED CEREBRAL VASOMOTOR RESPONSE IN NORMAL INDIVIDUALS AND PATIENTS WITH INTERNAL CAROTID-ARTERY OCCLUSIONS
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DOI：
10.1161/01.str.19.8.963
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发表时间：
1988-08-01
期刊：
影响因子：
8.3
通讯作者：
OTIS, SM
中科院分区：
文献类型：
--
作者：
RINGELSTEIN, EB;SIEVERS, C;OTIS, SM
为评价二氧化碳引起的脑血管舒缩反应，应用经颅多普勒超声检测了正常及不同程度高碳酸血症和低碳酸血症时大脑中动脉血流速度的相对变化。研究对象为40例正常人、40例单侧颈内动脉闭塞患者和15例双侧颈内动脉闭塞患者。当血流速度变化为正常二氧化碳分压的百分比与呼气末二氧化碳体积百分比时，双渐近曲线(正切-双曲线函数)给出散点图的最佳拟合度。上下渐近线之间的距离被定义为脑血管运动反应性。在正常人中，平均值为+-。SD血管舒缩反应性为85.63±-。15.96%。在颈内动脉闭塞的患者中，无论是闭塞组(平均45.2%，中位数50.4%；p<；0.001)和非闭塞组(平均+-)，血管运动反应性均显著低于正常。SD 67.7。+-。13.3%，P<；0.01)，双侧(平均+-)。SD 36.6。+-。15.9%和44.9.+-。双侧组24.6%，P<0.001)。有症状和无症状单侧闭塞的血管运动反应性之间的差异也非常显著(平均37.6%和62.9%，p<；0.006)。计算机断层扫描显示低流量脑梗塞患者的血管运动反应性也显著低于扫描正常的患者(平均值+-。SD 36.7。+-。25%和60.2.+-。16.9%，P<；0.0008)。低流量脑梗塞、缺血性眼病和短暂性短暂性脑缺血发作与34%的血管运动反应性甚至矛盾反应显著相关。经颅多普勒超声评价脑血管运动反应性是一种新的、可行的、非侵入性和可重复性的技术，可用于选择和量化真正的脑血管功能不全患者。
To evaluate the CO2-induced vasomotor reactivity of the cerebral vasculature, relative changes of blood flow velocity within the middle cerebral artery were measured by transcranial Doppler ultrasonography during normocapnia and various degrees of hypercapnia and hypocapnia. We studied 40 normal individuals and 40 patients with unilateral and 15 patients with bilateral internal carotid artery occlusions. When blood flow velocity changes as percent of normocapnic values were plotted against end-tidal CO2 volume percent, a biasymptotic curve (a tangent-hyperbolic function) gave the best fit of the scattergram. The distance between the upper and lower asymptotes was defined as cerebral vasomotor reactivity. In the normal individuals, mean .+-. SD vasomotor reactivity was 85.63 .+-. 15.96%. In patients with internal carotid artery occlusions, vasomotor reactivity was significantly lower than normal on both the occluded (mean 45.2%, median 50.4%; p < 0.001) and the nonoccluded (mean .+-. SD 67.7 .+-. 13.3%, p < 0.01) sides in the unilateral group and on both sides (mean .+-. SD 36.6 .+-. 15.9% and 44.9 .+-. 24.6%, p < 0.001) in the bilateral group. The difference between vasomotor reactivity for symptomatic and asymptomatic unilateral occlusions was also highly significant (mean 37.6% and 62.9%, p < 0.006). Vasomotor reactivity was also significantly lower in patients with low-flow infarctions on computed tomography than in patients with normal scans (mean .+-. SD 36.7 .+-. 25% and 60.2 .+-. 16.9%, p < 0.0008). A striking association of low-flow infarctions, ischemic ophthalmopathy, and hypostatic transient ischemic attacks was found with vasomotor reactivities of < 34% or even paradoxical reactions. Transcranial Doppler ultrasonographic evaluation of cerebral vasomotor reactivity is a new, feasible, noninvasive, and reproducible technique that allows selection and quantification of patients with true cerebrovascular insufficiency.