测量术中移植物血流预测烟雾病患者搭桥手术期间放射学高灌注。

IF 2 Q3 PERIPHERAL VASCULAR DISEASE
Cerebrovascular Diseases Extra Pub Date : 2020-01-01 Epub Date: 2020-07-29 DOI:10.1159/000508827
Akikazu Nakamura, Akitsugu Kawashima, Shunsuke Nomura, Takakazu Kawamata
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引用次数: 0

摘要

烟雾病(Moyamoya disease, MMD)是一种罕见的伴有脑梗死或脑出血的脑血管疾病。高灌注是直接搭桥手术最显著的并发症。先前的研究表明,脑血流量(CBF)的增加与症状性高灌注密切相关,并强调了术后评估CBF的重要性。目的:本研究的主要目的是定量分析术中移植物流量与CBF增加的关系,并评价MMD患者旁路手术术中移植物流量测量的有效性。方法:本研究纳入了2013年11月至2018年9月期间在我院接受直接血运重建术的67例连续成年烟雾病患者的91例手术。所有患者在吻合建立后,术中测量支主干的移植物流量。术后CBF测量在镇静下进行,手术后立即进行。放射学高灌注定义为局灶性高摄取,在手术后立即通过CBF成像确定。将患者分为影像学高灌注组和非影像学高灌注组,分析术中移植物血流与影像学高灌注的关系。结果:放射学高灌注组和非放射学高灌注组术中两支移植物流量均有显著差异(中位数分别为72 mL/min和42 mL/min;p < 0.01)和主干(中位数分别为113 vs 68 mL/min;P < 0.01)。进行了受体操作特征分析,以测试术中流量作为定量测量的效用。我们将术中分支和主干流量的临界值设置为57 mL/min(敏感性:0.707,特异性:0.702;曲线下面积[AUC]: 0.773;95%可信区间[CI]: 0.675-0.871)和84 mL/min(敏感性:0.667,特异性:0.771;AUC: 0.78;95% CI: 0.685-0.875)。结论:在搭桥手术中测量术中移植物流量可能是预测高灌注的有效手段,有助于早期治疗干预,如严格控制血压。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Measurement of Intraoperative Graft Flow Predicts Radiological Hyperperfusion during Bypass Surgery in Patients with Moyamoya Disease.

Measurement of Intraoperative Graft Flow Predicts Radiological Hyperperfusion during Bypass Surgery in Patients with Moyamoya Disease.

Measurement of Intraoperative Graft Flow Predicts Radiological Hyperperfusion during Bypass Surgery in Patients with Moyamoya Disease.

Introduction: Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF.

Objective: The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD.

Methods: This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed.

Results: Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p < 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p < 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675-0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685-0.875), respectively.

Conclusions: Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.

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来源期刊
Cerebrovascular Diseases Extra
Cerebrovascular Diseases Extra PERIPHERAL VASCULAR DISEASE-
CiteScore
3.50
自引率
0.00%
发文量
16
审稿时长
8 weeks
期刊介绍: This open access and online-only journal publishes original articles covering the entire spectrum of stroke and cerebrovascular research, drawing from a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. Offering an international forum, it meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues. The journal publishes original contributions, reviews of selected topics as well as clinical investigative studies. All aspects related to clinical advances are considered, while purely experimental work appears only if directly relevant to clinical issues. Cerebrovascular Diseases Extra provides additional contents based on reviewed and accepted submissions to the main journal Cerebrovascular Diseases.
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