颅脑损伤患者颅内动脉脉压振幅与脑自动调节功能之间的关联

Association between intracranial, arterial pulse pressure amplitudes and cerebral autoregulation in head injury patients.

作者信息

Eide P K, Czosnyka M, Sorteberg W, Pickard J D, Smielewski P

机构信息

Department of Neurosurgery, The National Hospital (Rikshospitalet), Oslo, Norway.

出版信息

Neurol Res. 2007 Sep;29(6):578-82. doi: 10.1179/016164107X172167.

DOI:10.1179/016164107X172167

PMID:17535570

Abstract

OBJECTIVE

To explore whether intracranial pulse pressure amplitudes relate to arterial pulse pressure amplitudes and whether correlations between time-related changes in intracranial and arterial pulse pressure amplitudes associate with indices of cerebral autoregulation.

METHODS

A total of 257 continuous and simultaneous intracranial pressure (ICP), arterial blood pressure (ABP) and middle cerebral artery (MCA) blood velocity recordings were obtained 1-14 days after ictus in 76 traumatic head injury patients and analysed retrospectively. Clinical outcome was assessed using the Glasgow outcome scale (GOS). Pulse pressure amplitudes of corresponding single ICP and ABP waves were correlated in consecutive 200 wave pairs. Mean ICP, mean ABP and mean ICP wave amplitudes, and mean and systolic MCA blood flow velocities, were computed in consecutive 6 second time windows. The indices of cerebral autoregulation PRx (moving correlation between mean ICP and mean ABP), and Mx and Sx (moving correlation between mean and systolic MCA blood velocity and cerebral perfusion pressure) were calculated over 4 minute periods and averaged over each recording.

RESULTS

Intracranial pulse pressure amplitudes were not related to arterial pulse pressure amplitudes (mean of Pearson's correlations coefficients: 0.04). Outcome was related to mean ICP, PRx and Sx (p </= 0.04, multiple regression analysis). Correlations between intracranial and arterial pulse pressure amplitudes were weakly related to PRx (Pearson's correlation coefficient: 0.16; p=0.01), but were not related to the indices of cerebral autoregulation Mx (Pearson's correlation coefficient: 0.07) and Sx (Pearson's correlation coefficient: 0.04).

CONCLUSIONS

In this cohort of pressure recordings, we found no evidence of a correlation between intracranial and arterial blood pressure amplitudes. The correlation appeared not to be related to the state of cerebral autoregulation, although a weak correlation was found with pressure reactivity index PRx.

摘要

目的

探讨颅内脉压幅度是否与动脉脉压幅度相关，以及颅内和动脉脉压幅度随时间变化的相关性是否与脑自动调节指标相关。

方法

回顾性分析76例创伤性颅脑损伤患者发病后1 - 14天连续同步记录的257次颅内压（ICP）、动脉血压（ABP）和大脑中动脉（MCA）血流速度。使用格拉斯哥预后量表（GOS）评估临床结局。在连续的200对波中，对相应的单个ICP和ABP波的脉压幅度进行相关性分析。在连续的6秒时间窗内计算平均ICP、平均ABP和平均ICP波幅度，以及平均和收缩期MCA血流速度。在4分钟时间段内计算脑自动调节指标PRx（平均ICP与平均ABP之间的移动相关性）、Mx和Sx（平均和收缩期MCA血流速度与脑灌注压之间的移动相关性），并对每次记录求平均值。

结果

颅内脉压幅度与动脉脉压幅度无关（Pearson相关系数均值：0.04）。结局与平均ICP、PRx和Sx相关（p≤0.04，多元回归分析）。颅内和动脉脉压幅度之间的相关性与PRx弱相关（Pearson相关系数：0.16；p = 0.01），但与脑自动调节指标Mx（Pearson相关系数：0.07）和Sx（Pearson相关系数：0.04）无关。