Tabuchi Sadaharu, Hirano Nobuo, Tanabe Michiharu, Kurosaki Masamichi, Okamoto Hisayo, Kamitani Hideki, Yokota Masayuki, Watanabe Takashi
Department of Neurosurgery, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago 683-8504, Japan.
Neurol Res. 2006 Mar;28(2):196-9. doi: 10.1179/016164105X48761.
Changes in systemic arterial blood pressure and the degree of cerebral vasospasm were investigated in 125 patients with aneurysmal subarachnoid hemorrhage.
Systemic arterial blood pressure was measured every 2 hours in each patient for a period of more than 2 weeks, and a fall in systemic blood pressure (FBP) was defined as a decrease of >40 mmHg of systolic blood pressure between two consecutive measurements.
A total of 91 FBPs occurred in 52 (41.6%) of 125 patients despite specific post-operative management to prevent hypovolemia. Five (5.5%) of the 91 FBPs occurred just before the onset of symptomatic vasospasm. Symptomatic vasospasm was observed in 36 (69.2%) of 52 patients with FBP and in 32 (43.8%) of 73 patients without FBP (p<0.01, chi-squared test). A hypodense area on computed tomographic scans in association with cerebral vasospasm was observed in 25 (48.1%) of 52 patients with FBP and in 21 (28.8%) of 73 patients without FBP (p<0.05).
We conclude that FBP might result from delayed cerebral vasospasm and/or brain dysfunction owing to subarachnoid hemorrhage itself.
对125例动脉瘤性蛛网膜下腔出血患者的全身动脉血压变化及脑血管痉挛程度进行研究。
对每位患者每2小时测量一次全身动脉血压，持续2周以上，将全身血压下降（FBP）定义为连续两次测量之间收缩压下降>40 mmHg。
尽管采取了特定的术后管理措施以预防血容量不足，但125例患者中有52例（41.6%）共发生了91次FBP。91次FBP中有5次（5.5%）恰好在症状性血管痉挛发作前出现。52例发生FBP的患者中有36例（69.2%）出现症状性血管痉挛，73例未发生FBP的患者中有32例（43.8%）出现症状性血管痉挛（卡方检验，p<0.01）。52例发生FBP的患者中有25例（48.1%）在计算机断层扫描中观察到与脑血管痉挛相关的低密度区，73例未发生FBP的患者中有21例（28.8%）观察到该低密度区（p<0.05）。
我们得出结论，FBP可能是由于蛛网膜下腔出血本身导致的延迟性脑血管痉挛和/或脑功能障碍所致。
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