高灌注综合征与临床 课件.ppt

Respiration Set for dynamic analysis CO2 Dynamic Analysis Normal mean values 5.26 +/- 1.61 % mmHg Absolute low limit 2.15 % mmHg Absolute Side difference 2.90 % mmHg Relative VMR reduction 2.15 %mmHg + SD 2.90 %mmHg Restrictive VMR 2.15 %mmHg Exhausted VMR 1.00 %mmhg CO2 Dynamic Analysis normal value 2.Asymptote range/ Vasomotor range CO2 increase with defined CO2/O2 gas Examination: Normocapnia Hypercapnia – O2/CO2 gas inspiration (ca 60 sec/steady state) Hypocapnia- hyperventilation Evaluation: 2 cycles of normo-, hyper- and hypocapnia Normal valuses :VMR 60% ( can be more than 100%) CO2 - Vasomotor range 3.Rate of change (? easy way“) VMR as increase of the CBF- inspiration of CO2/O2 gas Examination: Normocapnia Hypercapnia – inspiration of CO2/O2 gas Evaluation: Calculation of the difference between normo- and hypercapnia ( measured with a slope) Normal values: 15 – 25 % increase CO2 ?Rate of Change“ 4.Apnea method (? the too easy way“) VMR reactivity as the increase of the CBF per time period (quantitative examination“) Examination: Normocapnia Hypercapnia – holding the breath for about 30 sec. Evaluation: Calculation of the CBF slope per time (%/min.) Normal values: ? 72 +/- 36 %/min. ( 1.2+/- 0.6 %/sec.) CO2 ?the too easy way“ 5.Diamox test ( Azetazolamide) Increasing the CO2 concentration with an injection of a chemical stimulation ( ideal for non cooperative patients) Examination: Normocapnia Hypercapnia – injection of 1 gr. Diamox during 5 min. Evaluation: After 10 min. comparing normo-and hypercapnia by slope Normal values: 40% increasing - Path. low limit ? 10 % CO2 ? Diamox test“ Diamox test 正常值 Administration of acetazolamide induces a rapid and marked increase in CBF, ranging from 20% to 80% TCD with acetazolamide challenge is also able to assess cerebral vasoreactivity TCD cannot measure CBF it