超声评估远隔缺血适应对动脉瘤性蛛网膜下腔出血患者脑血流的影响

目的:探讨远隔缺血适应(RIC)对动脉瘤性蛛网膜下腔出血(aSAH)患者脑血流的影响。方法:选择2017年11月至2018年5月首都医科大学宣武医院神经外科重症监护病房连续收治的aSAH患者24例,所有患者在aSAH后72 h内接受动脉瘤夹闭和栓塞治疗,术后7 d内进行RIC干预5次。在RIC干预前、后采用经颅超声多普勒(TCD)评估脑血流,包括前循环:双侧大脑前动脉(ACA)、双侧大脑中动脉(MCA)、同侧MCA/颈内动脉(ICA)终末段血流速度比值(ratio);后循环:双侧大脑后动脉(PCA)、双侧椎动脉颅内段(VA)、基底动脉(BA)。RIC干预结束后复查头颅CT或MRI,判断有无新发梗死。结果:RIC干预后,患者前循环血流R-MCA、L-ACA及R-ratio较干预前升高(均P0.05),升高幅度均20%,其余参数差异无统计学意义(均P0.05)。RIC干预后,患者后循环血流L-VA及BA较干预前升高(均P0.05),升高幅度均20%,其余参数差异无统计学意义(均P0.05)。RIC干预结束后,CT或MRI均未发现新发脑梗死。结论:RIC干预在aSAH应用中对脑血流影响不明显,未导致新发脑梗死,其安全性得到初步证实。

Effect of Remote Ischemic Conditioning on Cerebral Blood Flow Evaluated by Transcranial Doppler in Patients with Aneurysmal Subarachnoid Hemorrhage

To explore the effect of remote ischemic conditioning (RIC) on cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: Included in this study were 24 aSAH patients consecutively admitted to the Intensive Care Unit of the Department of Neurosurgery at Xuanwu Hospital from November 2017 to May 2018. All patients underwent aneurysm clipping and embolization treatment within 72 hours of aSAH and received RIC 5 times within 7 days after treatment. Before and after RIC intervention, transcranial doppler (TCD) was used to evaluate cerebral blood flow in the anterior circulation, including that of the bilateral anterior cerebral arteries (ACA), bilateral middle cerebral arteries (MCA), and the ipsilateral MCA/ internal carotid artery (ICA) terminal section flow velocity ratio (ratio). The posterior circulation blood flow was also evaluated, including that at the bilateral posterior cerebral arteries (PCA), bilateral vertebral arteries (VA), and basilar artery (BA). Head CT or MRI recheck was performed after RIC intervention to evaluate the fresh infarctions. Results: Compared to data before RIC intervention, cerebral blood flow after intervention at the R-MCA, L-ACA, and R-ratio of the anterior circulation were increased (all P<0.05), with this increase being less than 20% , and the remaining parameters showed no significant difference (P>0.05). After RIC intervention, blood flow at the L-VA and BA of the posterior circulation were increased compared to those before intervention (all P0.05). Neither CT nor MRI showed fresh cerebral infarction after RIC intervention. Conclusion: RIC had no obvious effect on cerebral blood flow in patients with aneurysmal subarachnoid hemorrhage and did not trigger fresh cerebral infarctions. This study confirms the preliminary safety of RIC.