Acute middle cerebral artery occlusion: experience with volume expansion therapy.
Acute middle cerebral artery occlusion: experience with volume expansion therapy.
复制标题
急性大脑中动脉闭塞：扩容治疗的经验。
作者：
B. Tranmer;C. Gross;T. Keller;G. Kindt
连续5例大脑中动脉（MCA）闭塞后出现急性神经功能缺损的患者接受了胶体容量扩张的紧急治疗。在每一个病例中，诊断都通过计算机断层扫描和脑血管造影迅速得到证实。在神经功能缺损发作后2至18小时（平均11小时）开始积极的容量扩张治疗。使用的平均胶体体积为920 ml/天，平均4天。在容量扩张期间，平均心输出量增加57%，从4.6 +/- 0.6升/分钟增加到7.2 +/- 1.9升/分钟（P <0.05）。平均红细胞压积从46 +/- 3%降至37 +/- 4%（P <0.01）。平均动脉血压保持稳定，肺动脉楔压维持在15 mm Hg以下。3例患者在容量扩张治疗后显著改善，并恢复了以前的生活方式。2例患者部分恢复，并在家庭护理中管理。三名显著改善的患者是年轻人（年龄小于34岁），与老年患者相比，他们的心输出量增加更大（67%对19%）。没有重大并发症或死亡归因于扩容治疗。我们认为，血管内容量扩张及其伴随的心血管动力学增强可能是有效的治疗急性MCA闭塞后的急性神经功能缺损。
Five consecutive patients with acute neurological deficits after middle cerebral artery (MCA) occlusion were given emergency treatment with colloidal volume expansion. In each case, the diagnosis was confirmed promptly by computed tomography and cerebral angiography. Aggressive volume expansion therapy was started 2 to 18 hours (mean, 11 hr) after the onset of the neurological deficit. The mean colloidal volume used was 920 ml/day for an average of 4 days. During volume expansion, the mean cardiac output increased 57% from 4.6 +/- 0.6 to 7.2 +/- 1.9 litres/min (P less than 0.05). The mean hematocrit decreased 19% from 46 +/- 3% to 37 +/- 4% (P less than 0.01). The mean arterial blood pressure remained stable, and the pulmonary artery wedge pressure was maintained at less than 15 mm Hg. Three patients improved dramatically with volume expansion therapy and have returned to their previous life-styles. Two patients made partial recoveries and manage at home with nursing care. The three patients who improved dramatically were young (aged less than 34) and, when compared to the older patients, they had greater increases in cardiac output (67% vs. 19%). No major complications or deaths were attributed to the volume expansion therapy. We propose that intravascular volume expansion and its concomitant augmentation of the cardiovascular dynamics may be effective in the treatment of acute neurological deficits after acute MCA occlusion.