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

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

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

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.

Keywords:

Hemodilution, ischemic stroke, vasomotor reactivity, cerebral oximeter,

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