| ObjectiveThe purpose of this study was to evaluate the blood flow of the superficial temporal artery and its branches,and to provide a basis for the selection of STA graft.In order to maintain a good patency of the STA graft and anastomosis,increase intracranial blood perfusion after STA-MAC bypass;to improve the purpose of intracranial ischemic symptoms as much as possible,we study the antispasmodic effects and degree of action of three commonly used vasodilators(nitroglycerin,nimodipine,diltiazem)on the STA graft during the superficial temporal artery-middle cerebral artery bypass(STA-MAC).MethodsFrom January 2017 to December 2018,130 patients with moyamoya disease performed STA-MAC bypass in the fifth affiliated hospital of Zhengzhou University were selected,which were divided into three groups by random number table method(groupⅠwas nitroglycerin and the case was 44;groupⅡwas nimodipine and the case was 43;group Ⅲ was diltiazem and the case was 43).However,40 patients of them were excluded as a result of STA-MAC bypass was unsuccessful,serious complications in postoperative and so on,finally there were 90 patients available(.groupⅠ,Ⅱ,Ⅲ was 30 case,respectively).Three drugs were continuously pumped at 0.3~0.5μg·kg-1·min-1 during the Perioperative.We selected the preoperative(T1),immediately after extubation(T2),3 days after operation(T3)and 7days after operation(T4)as the observation point,and then using the vascular ultrasound to measure the three groups index of STA,including maximum flow velocity(Vmax),the minimum flow velocity(Vmin),the mean flow velocity(Vm),resistance index(RI),inside diameter(ID)of the STA trunk and branch,and record MAP,HR and CVP of the patient at the time of T1 and T2.The measurement of blood flow indicators in all patients was performed by the same person,and surgery for all patients was performed by the same team of experts.Results(1)Our research results showed that the superficial temporal artery was used as the graft vessel in 52 cases,of which 51 cases were detected by ultrasound.38 patients underwent superficial temporal artery transplantation,33 of which were consistent with ultrasound findings.The groupⅠwas 27(90.00%)The groupⅡwas 29(96.70%)The groupⅢwas 28(93.30%).(2)Compared with T1,the Vmax,Vmin,Vm and ID of the 3 groups increased at the time of T2,and the increase of the Vmax,Vmin and Vm in theⅡgroup was statistically significant(P<0.05).The increase of ID in groupⅠ,Ⅱand Ⅲwas statistically significant(P<0.05).At the time of T3 and T4,Vmax,Vmin,Vm and ID increased,RI and PI decreased,and the difference was statistically significant(P<0.05).At time T4,compared with groupⅠ,the Vmax,Vmin,and Vm in groupⅡandⅢincreased,the PI and RI decreased in groupⅡandⅢ,and the difference was statistically significant(P<0.05).Compared with groupⅢ,the Vmin,Vm increased and PI decreased in groupⅡ,the difference was statistically significant P<0.05).The Vmax,Vmin,and Tmax values increased and the PI and RI values decreased in the grop of nitroglycerin with the postoperative time.Compared with the nitroglycerin and diltiazem groups,the difference was significant(P<0.05).The ID values increased,and the difference was not statistically significant(P>0.05).Conclusion(1)Vascular ultrasound can be used to guide the choice of blood vessels during the bypass of moyamoya patients;The blood flow of the STA graft can be indirectly determined by comparing the blood flow of the superficial temporal artery before and after surgery.(2)Nimodipine is superior to diltiazem and nitroglycerin in the relaxation and antispasmodic effects of STA grat.Diltiazem is superior to nitroglycerin in relaxing and antispasmodic effects on STA graft.Nimodipine is preferred for STA-MAC bypass in patients with moyamoya disease. |
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