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Titolo:
Regional cerebral blood flow autoregulation in patients with fulminant hepatic failure
Autore:
Larsen, FS; Strauss, G; Moller, K; Hansen, BA;
Indirizzi:
Univ Copenhagen, Dept Hepatol, Rigshosp, DK-2100 Copenhagen, Denmark Univ Copenhagen Copenhagen Denmark DK-2100 , DK-2100 Copenhagen, Denmark Univ Copenhagen, Dept Infect Dis, Rigshosp, DK-2100 Copenhagen, Denmark Univ Copenhagen Copenhagen Denmark DK-2100 , DK-2100 Copenhagen, Denmark
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 6, volume: 6, anno: 2000,
pagine: 795 - 800
SICI:
1527-6465(200011)6:6<795:RCBFAI>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSCRANIAL DOPPLER SONOGRAPHY; INDUCED BRAIN EDEMA; ACUTE LIVER-FAILURE; PORTACAVAL ANASTOMOSIS; RATS; HYPOTHERMIA; CIRCULATION; METABOLISM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Larsen, FS Univ Copenhagen, Dept Hepatol, Rigshosp, A-2121,Blegdamsvej 9, DK-2100 Copenhagen, Denmark Univ Copenhagen A-2121,Blegdamsvej 9 Copenhagen Denmark DK-2100
Citazione:
F.S. Larsen et al., "Regional cerebral blood flow autoregulation in patients with fulminant hepatic failure", LIVER TRANS, 6(6), 2000, pp. 795-800

Abstract

The absence of cerebral blood flow autoregulation in patients with fulminant hepatic failure (FHF) implies that changes in arterial pressure directlyinfluence cerebral perfusion. It is assumed that dilatation of cerebral arterioles is responsible for the impaired autoregulation. Recently, frontal blood flow was reported to be lower compared with other brain regions, indicating greater arteriolar tone and perhaps preserved regional cerebral autoregulation. In patients with severe FHF (6 women, 1 man; median age, 46 years; range, 18 to 55 years), we tested the hypothesis that perfusion in the anterior cerebral artery would be less affected by an increase in mean arterial pressure compared with the brain area supplied by the middle cerebral artery Relative changes in cerebral perfusion were determined by transcranial Doppler-measured mean flow velocity (V-mean), and resistance was determined by pulsatility index in the anterior and middle cerebral arteries. Cerebral autoregulation was evaluated by concomitant measurements of mean arterial pressure and V-mean in the anterior and middle cerebral arteries duringnorepinephrine infusion. Baseline V-mean was lower in the brain area supplied by the anterior cerebral artery compared with the middle cerebral artery (median, 47 cm/s; range, 21 to 62 cm/s v 70 cm/s; range 43 to 119 cm/s, respectively; P < .05). Also, vascular resistance determined by pulsatility index was greater in the anterior than middle cerebral artery (median, 1.02; range 1.00 to 1.37 v 0.87; range 0.75 to 1.48; P < .01). When arterial pressure was increased from 84 mm Hg (range 57 to 95 mm Hg) to 115 mm Hg (range, 73 to 130 mm Hg) during norepinephrine infusion, V-mean remained unchanged in 2 patients in the anterior cerebral artery, whereas it increased in the middle cerebral artery in all 7 patients. In the remaining patients, V-mean increased approximately 25% in both the anterior and middle cerebral arteries. Thus, this study could only partially confirm the hypothesis that autoregulation is preserved in the brain regions supplied by the anterior cerebral artery in patients with FHF. Although the findings of this small study need to be further evaluated, one should consider that autoregulation may be impaired not only in the brain region supplied by the middle cerebralartery, but also in the area corresponding to the anterior cerebral artery.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 13/08/20 alle ore 14:33:37