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首页> 外文期刊>Annals of vascular surgery >Post-carotid endarterectomy hyperperfusion syndrome-is it predictable by lack of cerebral reserve?
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Post-carotid endarterectomy hyperperfusion syndrome-is it predictable by lack of cerebral reserve?

机译：颈动脉内膜切除术后过度灌注综合征-是否可以通过缺乏脑储备来预测？

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BACKGROUND: Cerebral hyperperfusion syndrome (HS) is presumed to be because of an increase in postendarterectomy flow in patients with fixed cerebral vascular reserve. Severe headache is thought to be an early sign of possible HS. An increase in partial pressure CO (pCO) is known to cause cerebral vasodilatation and is used to evaluate the presence of cerebral reserve. METHODS: A total of 45 patients undergoing carotid endarterectomy had internal carotid artery flow measured with a transonic flow probe as follows: F1, immediately after full dissection of the internal carotid artery; F2, after 30 seconds of breath holding; and F3, after restoration of flow. DeltaF2-F1 and DeltaF3-F2 were also evaluated. A 10% increase between F2 and F1 indicated normal cerebral reserve and between F3 and F2 indicated increased postoperative flow. Age, gender, medical comorbidities, indication for carotid endarterectomy, intraoperative cerebral oximetry values, and percentage of bilateral carotid stenosis were recorded. All patients were contacted after discharge about the presence of postoperative headache or other suggestions of HS. Fisher's exact test was used for categorical predictors and the rank-sum test for continuous predictors. RESULTS: Seven (16%) patients (group A) developed postoperative headache and 38 (group B) did not. No patient developed HS. No variables were associated with postoperative headache except for female gender (p = 0.005). There were no statistically significant differences in F1, F2, F3, and DeltaF (F2-F1 or F3-F2) between groups A and B (there was no descriptively significant DeltaF2-F1 in 17 patients). Only one of the nine patients who had no change between F2 and F1, who had a significant increase in F3, and who was thought to be at higher risk for HS developed a postoperative headache. CONCLUSIONS: Lack of cerebral reserve is common in patients undergoing endarterectomy. If headache is an early sign of hyperperfusion, it does not seem to be predicted by lack of cerebral reserve and an increase in postendarterectomy flow.
机译：背景：推测脑高灌注综合征（HS）是由于脑血管储备固定的患者行动脉内膜切除术后流量增加所致。严重头痛被认为是可能发生HS的早期迹象。已知分压CO（pCO）的增加会引起脑血管舒张，并用于评估脑储备的存在。方法：总共45例接受颈动脉内膜切除术的患者使用跨音速血流探头对颈内动脉血流进行了如下测量：F1，颈内动脉完全解剖后立即进行; F2，屏住呼吸30秒后; F3，恢复流量后。还评估了DeltaF2-F1和DeltaF3-F2。 F2和F1之间增加10％表示大脑储备正常，F3和F2之间表明术后流量增加。记录年龄，性别，合并症，颈动脉内膜切除术的适应症，术中脑血氧饱和度值和双侧颈动脉狭窄百分比。出院后就所有患者的术后头痛或HS的其他建议与所有患者进行联系。 Fisher的精确检验用于分类预测变量，秩和检验用于连续的预测变量。结果：七名（16％）患者（A组）出现术后头痛，而38名（B组）未出现头痛。没有患者出现HS。除女性外，其他变量均与术后头痛无关（p = 0.005）。 A组和B组之间的F1，F2，F3和DeltaF（F2-F1或F3-F2）在统计上没有显着差异（17名患者中没有描述性的显着DeltaF2-F1）。在F2和F1之间无变化，F3显着增加并且被认为是HS风险较高的9名患者中，只有一名发生了术后头痛。结论：内膜切除术患者脑储备不足是常见的。如果头痛是过度灌注的早期征兆，似乎不能通过缺乏大脑储备和动脉内膜切除术后流量增加来预测。

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