脳血管閉塞症に対する急性期血行再建術の実験的研究 : 特に残存脳血流量,脳水分,電解質含量を中心に

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The relationship between residual cerebral blood flow and cerebral edema as well as hemorrhagic infarction seen following acute restoration of cerebral blood flow in an ischemic brain was experimentally studied. Dogs were divided into two groups with different mean arterial blood pressures (MABP) which were sustained at low levels by arterial exsanguination pretreatment : Group A with MABP of 40mmHg and group B with MABP of 60mmHg. The right middle cerebral artery (MCA) was occluded by an aneurysmal clip for one hour under these two hypotension levels. The occlusion was then released and MABP recovered towards normal levels. In group A, MCA occlusion brought the local cerebral blood flow (ICBF) down to less than 8ml/100g/min. from 69ml/100g/min. Ten minutes after the release of MCA occlusion, the 1CBF increased to 109ml/100g/min. and was recognized as reactive hyperemia. Ninety minutes after the release, marked subarachnoid hemorrhage was seen in 5 out of 14 animals, and Evans Blue was extravasated into the corebrat tissue in one of three. Evidences of accumulation of water (85%) and sodium(555mEq/kg), and decreases of potassium (395mEq/kg) in the cerebral cortex were observed 6 hours after the release of MCA occlusion. The 1CBF in group B decreased to 20ml/100g/min. from 54ml/100g/min. after MCA occlusion. It regained its previous levels however, with or without mild reactive hyperemia after the release of the MCA occlusion. No subarachnoid hemorrhage or extrava-sation of Evans Blue or changes in the cerebral water and electrolyte contents were recognized. When the residual cerebral blood flow is extremely limited, as in group A, the acute restoration of the blood flow by bypass surgery may be dangerous because of possible complications such as hemorrhagic infarction or severe edema, even if done within a short period after occlusion. The same procedure could, however, be performed without any complication if it is done within a short period after the onset of occlusion and if the residual cerebral blood flow of the ischemic area is maintained at a level of 20ml/100g/min. or approximately 37% of its previous level.
日本脳神経外科学会の論文
1982-11-15

脳血管閉塞症に対する急性期血行再建術の実験的研究 : 特に残存脳血流量,脳水分,電解質含量を中心に

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