围术期脑保护的研究进展PPT课件
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The primary outcome measure was the rate of poor outcome (ie, GOS showing severe disability, vegetative state, or death).
.
6
This trial was terminated prematurely due to futility. There was no difference in the rate of poor outcome (60% vs. 45% for hypothermia and normothermia, respectively; P=0.67) or death (23% vs. 14%, P=0.52).
.
11
For fasting plasma glucose concentrations >110 mg/dL, each 10 mg/dL increase in serum glucose concentration was associated with a 6% greater risk of fatal stroke events (P=0.05) and an 8% increase in nonfatal stroke events (P<0.05).
.
9
Sui reported data from 43,933 men who
underwent a comprehensive preventative medical between 1971 and 2002 （were free
of myocardial infarction, stroke, cancer, or known diabetes mellitus）
.
3
1． 1 选择性脑降温
1． 2 控制血糖
1． 3 控制血压和保证氧供
1. 4 血红蛋白浓度
.
4
选择性脑降温是指在离头部较近处加强热 量散发，使颅内温度低于躯体温度，可以 避免全身低温所带来的不利影响，同时又 能有效地改善缺血缺氧性脑损伤。
脑保护机制不仅与降低脑代谢率有关，还 涉及抑制缺血缺氧诱发的“瀑布式反应” 的进展，如抑制谷氨酸释放、减少自由基 生成、抑制凋亡、保护血脑屏障等，并且 可为其他治疗措施延长治疗时间窗。
They were followed until either stroke, death, or the study end date (December 31, 2004) occurred.
.Hale Waihona Puke Baidu
10
BG concentrations were stratified into 3 groups: (1) normal (80 to 109 mg/dL); (2) impaired (110 to 125 mg/dL); and (3) diabetes mellitus (>=126 mg/dL).
解轶 2012年3月
.
1
尽管近年麻醉技术及监测手段不断进步，但 是术中与术后神经损伤仍是最严重的并发症。
目前尚无足够的临床证据制订的官方指南， 其主要原因是脑缺血机制错综复杂。
对脑缺血高风险患者不仅要避免不利因素的 影响，而且要积极采取措施来保护神经系统 功能稳定。
.
2
在一些特殊的外科手术中应用各种手段来 提高脑组织对缺血缺氧的耐受力，减少缺 血缺氧所导致的神经细胞死亡和神经功能 受损，已成为围术期脑保护迫切需要解决 的重大课题。
Very early hypothermia induction in patients with severe brain injury (the National
Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol. 2011;10:131–139.
A prospective study of fasting plasma glucose and risk of stroke in asymptomatic men. Mayo Clin Proc. 2011;86:1042–1049.
.
12
Kamouchi utilized data from 3627 patients
.
7
不过有一点可以肯定:
围术期高热会使临床结局变得更差
.
8
大量研究证实，围术期控制血糖有助于改善患 者神经功能预后。
在一些危重和心脏手术患者中，严格控制围术 期的血糖水平可以降低脑缺血发病率和病死率。
围术期持续高血糖可增加缺血性脑损伤的范围， 使得临床结局更差。McGirt 的研究发现，血糖 ＞ 11． 11 mmol /L ( 无论患者是否患有糖尿病) 可使颈动脉内膜剥脱术围术期脑卒中发生率增 高。但是严格的血糖控制( 4． 44～ 6． 11 mmol /L) 可能会增加低血糖的风险。
Nonfatal stroke rate was 10.3, 11.8, and 18.0 per 10,000 person-years in the 3 groups (P=0.002). Fatal stroke, with stroke rates of 2.1, 3.4, and 4.0 per 10,000 person-years (P=0.008).
with primary ischemic stroke with a
hemoglobin A1c available from hospital admission.
.
5
The National Acute Brain Injury Study: Hypothermia II was a randomized multicenter trial in which 97 patients with moderate-tosevere TBI received either normothermia or total-body hypothermia to 33°C for 48 hours.
.
6
This trial was terminated prematurely due to futility. There was no difference in the rate of poor outcome (60% vs. 45% for hypothermia and normothermia, respectively; P=0.67) or death (23% vs. 14%, P=0.52).
.
11
For fasting plasma glucose concentrations >110 mg/dL, each 10 mg/dL increase in serum glucose concentration was associated with a 6% greater risk of fatal stroke events (P=0.05) and an 8% increase in nonfatal stroke events (P<0.05).
.
9
Sui reported data from 43,933 men who
underwent a comprehensive preventative medical between 1971 and 2002 （were free
of myocardial infarction, stroke, cancer, or known diabetes mellitus）
.
3
1． 1 选择性脑降温
1． 2 控制血糖
1． 3 控制血压和保证氧供
1. 4 血红蛋白浓度
.
4
选择性脑降温是指在离头部较近处加强热 量散发，使颅内温度低于躯体温度，可以 避免全身低温所带来的不利影响，同时又 能有效地改善缺血缺氧性脑损伤。
脑保护机制不仅与降低脑代谢率有关，还 涉及抑制缺血缺氧诱发的“瀑布式反应” 的进展，如抑制谷氨酸释放、减少自由基 生成、抑制凋亡、保护血脑屏障等，并且 可为其他治疗措施延长治疗时间窗。
They were followed until either stroke, death, or the study end date (December 31, 2004) occurred.
.Hale Waihona Puke Baidu
10
BG concentrations were stratified into 3 groups: (1) normal (80 to 109 mg/dL); (2) impaired (110 to 125 mg/dL); and (3) diabetes mellitus (>=126 mg/dL).
解轶 2012年3月
.
1
尽管近年麻醉技术及监测手段不断进步，但 是术中与术后神经损伤仍是最严重的并发症。
目前尚无足够的临床证据制订的官方指南， 其主要原因是脑缺血机制错综复杂。
对脑缺血高风险患者不仅要避免不利因素的 影响，而且要积极采取措施来保护神经系统 功能稳定。
.
2
在一些特殊的外科手术中应用各种手段来 提高脑组织对缺血缺氧的耐受力，减少缺 血缺氧所导致的神经细胞死亡和神经功能 受损，已成为围术期脑保护迫切需要解决 的重大课题。
Very early hypothermia induction in patients with severe brain injury (the National
Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol. 2011;10:131–139.
A prospective study of fasting plasma glucose and risk of stroke in asymptomatic men. Mayo Clin Proc. 2011;86:1042–1049.
.
12
Kamouchi utilized data from 3627 patients
.
7
不过有一点可以肯定:
围术期高热会使临床结局变得更差
.
8
大量研究证实，围术期控制血糖有助于改善患 者神经功能预后。
在一些危重和心脏手术患者中，严格控制围术 期的血糖水平可以降低脑缺血发病率和病死率。
围术期持续高血糖可增加缺血性脑损伤的范围， 使得临床结局更差。McGirt 的研究发现，血糖 ＞ 11． 11 mmol /L ( 无论患者是否患有糖尿病) 可使颈动脉内膜剥脱术围术期脑卒中发生率增 高。但是严格的血糖控制( 4． 44～ 6． 11 mmol /L) 可能会增加低血糖的风险。
Nonfatal stroke rate was 10.3, 11.8, and 18.0 per 10,000 person-years in the 3 groups (P=0.002). Fatal stroke, with stroke rates of 2.1, 3.4, and 4.0 per 10,000 person-years (P=0.008).
with primary ischemic stroke with a
hemoglobin A1c available from hospital admission.
.
5
The National Acute Brain Injury Study: Hypothermia II was a randomized multicenter trial in which 97 patients with moderate-tosevere TBI received either normothermia or total-body hypothermia to 33°C for 48 hours.