Evaluation The Efficiency of Hemodilution with Vasomotor Reactivity and Cerebral Oximeter in Acute Ischemic Stroke Treatment

Yıl 2020, Cilt: 42 Sayı: 2, 203 - 211, 17.03.2020

İrfan Yavaş , Demet Özbabalık Adapınar

https://doi.org/10.20515/otd.541616

Öz

Hemodilution (HD) which
increases cerebral blood flow has a neuroprotective effect. We aim to test
short and long term results of this effect with vasomotor reactivity test and
cerebral oximetry Materials and Methods: Patients who had an ischemic stroke
were included in the study consecutively. Hemodilution was performed
hipervolemic, isovolemic and hypovolemic according to hematocrit levels and
performed within first 24 hours. Patients underwent vasomotor reactivity test
(VMR) with transcranial doppler ultrasonography, distribution of oxygen was
measured with INVOS 3100 Cerebral Oximeter and simultaneous clinical
assessments were done with Glascow Coma Scale, Bartel Index, Rankın Score, MCA
Neurological Scale, Scandinavian Stroke Scale and Hemispheric Stroke Scale.
These assessments were done in the first day, 5 days and 90 days after HD. The
results were analyzed by descriptive statistics, variant analysis and t-test Result:
We enrolled 21 patients whom hemodilution was performed and 20 control subjects
in our study. Mean age of all subjects was 61.2 years. There was no significant
difference between the two groups oxygen levels cerebral oximetry and results
of vasomotor reactivity test. Hemodilution group had better clinical recovery
in the third month. Hemodilution had no effect in VMR test and distribution of
oxygen but it contributed to clinical recovery in long term. 

Anahtar Kelimeler

Hemodilution, ischemic stroke, vasomotor reactivity, cerebral oximeter

Akut İskemik Strok Tedavisinde Hemodilüsyonun Etkinliğinin Vasomotor Reaktivite ve Serebral Oksimetre ile Değerlendirilmesi

Öz

Hemodilüsyon serebral kan akımını
artırarak nöroprotektif etki göstermekte. Bu etkinin kısa ve uzun vadedeki
sonuçlarını vasomotor reaktivite testi ve serebral oksimetre ile test etmeyi
amaçladık. Gereç ve yöntemler: İskemik stroklu hastalar ardışık sistemle
hemodilüsyon ve kontrol grubuna kabul edildi. Hemodilüsyon ilk 24 sa içinde
uygulandı. Hematokrit düzeyine göre hipervolemik, izovolemik ya da hipovolemik
hemodilüsyon uygulandı. Hemodilüsyon öncesi, sonrası 5.gün ve 90.gün
transkranial doppler ile vasomotor reaktivite (VMR) testi, INVOS 3100 Cerebral
Oximeter ile oksijen dağımı ve klinik değerlendirmeleri yapıldı. Klinik
değerlendirmede Glaskow koma skalası, Bartel, Rankın, SSS, MCANS, HSS
kullanıldı. Sonuçlar descriptive statistics, varyans analizi ve t- test ile
değerlendirildi. Bulgular: Hemodilüsyon grubunda 21, kontrol grubunda 20 hasta
vardı. Yaş ortalaması 61,2 idi. VMR testinde ve oksimetride oksijen değerlerinde
iki grup birbiri ile ve günlere göre karşılaştırmada anlamlı bir farklılık
bulunmamıştır. Klinik değerlendirmede 90. Günde hemodilüsyon grubunda SSS ve
MCANS değerleri daha iyi bulunmuştur. Hemodilüsyon WMR testinde ve oksijen
dağılımında anlamlı bir etki göstermemiştir. Uzun dönemde klinik iyileşmede
etkili bulunmuştur.

Anahtar Kelimeler

Hemodilüsyon, İskemik strok, vasomotor reaktivite, serebral oksimetre

Kaynakça

• 1. Feng R, Badgeley M, Mocco J, Oermann EK. Deep learning guided stroke management: a review of clinical applications. J Neurointerv Surg 2018 Apr; 10(4): 358-362
• 2. Torun S. Hemoreolojik yaklaşımlar. Özdemir G. İskemik strok akut tedavi ilkeleri. Beyin Damar Hastalıkları Derneği Yayın no:2, 1995, 47-58
• 3. Tu YK, Heros RC, Karacostas D et al. Isovolomic hemodilution in experimental focal cerebral ischemia part 2: effect on regional cerebral blood flow and size of infarction. J Neurosurg 1988; 69: 82-91
• 4. Chang CK, Chien CH, Chou HL, Lin MT. The protective effect of hipervolemic hemodilution in experimental heart stroke. Shock 2001; 16: 153-158
• 5. Lin SZ, Chiou TL, Song WS, Chiang YH. Isovolomic hemodilution normalizes the prolonged passage of red cells and plasma through cerebral micro vessels in the partially ischemic forebrain of rats. J Cereb Blood Flow Metab 1996; 16: 280-289
• 6. Schell RM, Cole DJ, Schultz RL, Osborne TN. Temporary cerebral ischemia effects of pentastarch of albumin on reperfusion injury. Anesthesiology 1992; 77: 86-92
• 7. L. Xiong, C. Lei, Q. Wang, W. Li. Acute normovolemic hemodilution with a novel hydroxyethyl starch (130/0,4) reduces focal cerebral ischemic injury in rats. European Journal of Anasthesiology 2008; 25: 581-588
• 8. Perez- Trepichio AD, Furlan AJ, Little JR, Jones SC. Hydroxyethyl starch 200/0,5 reduces infarct volüme after embolic stroke in rats. Stroke 1992; 23: 1782-1790
• 9. Sacco S, Marini C, Olivieri L, Pistoia F, Carolei A. Contribution of hematocrit to early mortality after ischemic stroke. Eur Neurol 2007; 58(4): 233-8
• 10. Lee SH, Heros RC, Mullan JC, Karosue K. Optimum degree of hemodilutiın for brain protection in a cannin model of focal cerebral ischemia. J Neurosurg 1994; 80: 469-473
• 11. Belayev L, Busto R, Zhao W, Clemens JA, Ginsberg MD. Effect of delayed albümin hemodilution on infarction volüme and brain edema after transient middle cerebral arter occlusion in rats. J Neurosurg 1997; 87(4): 595-601
• 12. Goulin GD, Duthie SE, Zornow MH, Scheller MS, Peterson BM. Global cerebral ischemia effects of pentastarch after reperfusion. Anesth Analg 1994; 79: 1036-1042
• 13. Ohtaki M, Trammer BI. Role of hypervolemic hemodilution in focal cerebral ischemia of rats. Surg Neurol 1993; 40: 196-206
• 14. Goslinga H, Eijzenbach V, Heuvelmans JH, Van-der-Laan-de-Vries-E, Melis UM, Schmid Schonbein H, Bezemer PD. Custom-tailored hemodilution with albümin and crystalloids in acute ischemic stroke. Stroke 1992; 23(2): 181-8
• 15. Mast H, Marx P. Neurological deterioration under isovolemic hemodilution with hydroxyethylstarch in acute cerebral ischemia. Stroke. 1991; 22: 680-683
• 16. Asplund K, Israelsson K, Schampi I. Hemodilution for acute ischemic stroke. Cochrane Database Syst Rev 2000; (2): CD000103
• 17. Edward C. Jauch et al. Guidelines fort he early management of patients with acute ischemic stroke. Stroke. 2013; 44: 870-947
• 18. Chang TS, Jensen MB. Hemodilution for acute ischemic stroke. Cochrane Database Syst Rev. 2014(8) CD000103 Stroke 2015; 46: e4-e5
• 19. Tu YK, Heros RC, Candis G, Hyoda A, Lagree K, Callahan R, Zerves NT, Karacostas D. Isovolemic hemodilution in experimental focal cerebral ischemia effect on hemodinamics, hemorheology and intracranial pressure. J Neurosurg 1988; 69: 72-81
• 20. Wood JH, Simeone FA, Fink EA, Golden MA. Hypervolemic hemodilution in experimental focal cerebral ischemia. Elevation of cardiac ouput, regional cortical blood flow and ICP after intravascular volüme expansion with low molecular weight dextran. J Neurosurg 1983; 59: 500-509
• 21. Kellert L. Et al. Cerebral oxygen transport failure?: Decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality. Stroke 2011; 42: 2832-2837
• 22. Hemodilution in stroke study group. Hypervolemic hemodilution treatment of acute stroke. Results of a randomized multicenter trial pantastarch. Stroke 1989; 20: 317-323
• 23. Miller JB, Lewandowski C, Wira CR, Taylor A, Burmeister C, Welch R. Volume of plasma expansion and functional outcomes in stroke. Neurocrit Care 2017; 26(2): 191-195