摘要目的 为进一步证明高灌注的存在和高灌注损害发生的最危险时间窗,以便指导术后临床治疗、预防高灌注再损伤及高灌注突破出血可能性.方法 对象为2008年8月至2009年12月在北京天坛医院行颞浅动脉-大脑中动脉搭桥(STA-MCA)术治疗的烟雾病患者35例,男22例,女13例,年龄5 ～55岁,平均29岁,其中儿童10例.应用激光多普勒(LDF)连续分别测量吻合前、吻合刚完、麻醉刚醒、术后第1天、第2天、第3天、第4天、第5天及第6天的局部脑皮层血流变化值( PU值),从而得到局部脑血流灌注变化趋势.结果 吻合前局部皮层平均脑血流值(即LDF的基线值)(69±24) PU、吻合刚完时是(66±74) PU、麻醉清醒时(123±23) PU、术后第1天(297±17) PU、第2天(302 ±31)PU、第3天(317±26)PU、第4天(272±46) PU、第5天(363±54) PU及第6天(367±24) PU.结论 进一步证实了STA-MCA术后存在局部高灌注,发现了高灌注损伤可能发生的最危险时间窗.证实了STA-MCA吻合术对烟雾病是个安全而有效的治疗手段,它能够明显地增加局部脑皮层的血流灌注.

abstractsObjective To explore the changes of regional cerebral blood flow at the site of anastomosis of superficial temporal artery-middle cerebral artery (STA-MCA) to guide the preventive treatment of symptomatic hyperperfusion.Methods A total of 35 patients with Moyamoya disease were recruited from Beijing Tiantan Hospital.There were 22 males and 13 females with an average age of 29 years (range:5 -55).And there were 10 children.Regional cortical blood flow (rCBF) was measured by Laser Doppler flowmeter (LDF) before,after and at Day 1,2,3,4,5 and 6 postoperation of STA-MCA anastomosis.The probe of LDF was implanted adjacent to the area of anastomosis for 144 hours to record the values of rCBF.Results The baseline LDF values of cortical rCBF near the area of anastomosis were ( 69 ±24) PU before anastomosis,(66 ±74) PU immediately after anastomosis,(123 ±23) PU at the conscious time after anesthesia postoperation,(297 ± 17) PU at Day 1 postoperation.And the LDF values of the following5 days were (302 ±31),(317 ±26),(272 ±46),(363 ±54) and (367 ±24) PU respectively.Conclusion As a safe and effective treatment for Moyamoya disease,STA-MCA anastomosis has great risks for symptomatic hyperperfusion.The highest risk time for hyperperfusion is identified after STA-MCA.