体外反搏对脑循环血流动力学的改变_leung英.ppt

Hemodynamic Changes in Cerebral Circulation during External Counterpulation (ECP): An Experience in Stroke Patients Healthy Controls体外反搏对脑循环血流动力学的改变 Cerebral blood flow augmentation is important in stroke management 改善脑血流是中风治疗的主要目标 Methods to improve cerebral blood flow 改善脑血流的方法 Rationale Possible Mechanisms Cerebral flow augmentation 1 脑血流增加 Improve collateral circulation 改善侧枝循环 Angiogenesis 2 血管新生 VEGF Open preformed collateral channels 3 开放侧枝循环血管 NO Endothelin-1 Methods to Evaluate Cerebral Blood Flow 评价脑血流的方法 External Counterpulsation (ECP) for Atherosclerotic Stroke StudY- A pilot study (EASY Pilot study)  Baseline Data 21 pts enrolled, mean NIHSS 8.8 on admission 21例病人纳入研究， 基线NIHSS 8.8 分 Clinical Outcomes at 90 days 临床疗效 11 pts (52.4%) had a NIHSS ≤ 2 13 pts (61.9%) had a mRS ≤ 2 Among 9 patients with an initial limb power of 0/5 before the start of ECP, 4 (44.4%) had a power of grade 4 or above 50% 病人NIHSS 或mRS ≤ 2 分，开始反搏前肌力0级的9例病人中4例肌力4级或以上 Hemodynamic Changes 脑血流动力学改变 A mean increase of 8.8% in mean BP 平均血压升高8.8% A 10.3% increase in mean CBFV in the relevant MCA, and 6.3% increase in the irrelevant side 患侧MCA脑血流速度增加10.3%， 对侧MCA脑血流速度增加6.3% A trend of greater increase in mean CBFV in pts with good functional outcome 功能恢复良好者反搏过程中MCA脑血流速度增加较多 Conclusions ECP may improve neurological, functional recovery of ischemic stroke ECP可改善中风病人神经和肢体功能的恢复 Cerebral perfusion enhancement was documented by TCD and CVIQ TCD和CVIQ检查发现反搏过程中脑血供有所改善 ECP’s may serve as a promising treatment option for ischemic stroke patients and is worthy of further investigation ECP对中风病人的临床疗效有待于进一步的研究 * Dr. Thomas Leung Director of Acute Stroke Unit Prince of Wales Hospital The Chinese University of Hong Kong How to Improve Cerebral Blood Flow? 如何改善脑血流 Thrombolysis 溶栓 Angioplasty / stenting 支架成型术 Open artery directly 打通血管 Systemic strategies 体循环 Diastol