Department of Psychiatry and Psychotherapy, Philosophenweg 3, University Hospital, Jena, Germany.
Drug Alcohol Depend. 2010 Aug 1;110(3):240-6. doi: 10.1016/j.drugalcdep.2010.03.007. Epub 2010 Apr 24.
Heavy alcohol consumption increases the risk for all major types of stroke and is associated with autonomic dysfunction during alcohol withdrawal syndrome (AWS). Cerebral autoregulation is the mechanism by which cerebral perfusion is maintained stable, representing an intrinsic protective system of the cerebral circulation. Here, we aimed to analyze the influence of acute AWS on cerebral hemodynamics in alcohol-dependent patients. We investigated 20 men in the unmedicated acute state of AWS and repeated the investigation 24h after initiation of clomethiazole treatment. Dynamic cerebral autoregulation (dCA) was assessed by the correlation coefficient index and transfer function analysis (phase and gain) from oscillations of arterial blood pressure and cerebral blood flow velocity (CBFV). The vasomotor reserve (VMR) was measured by the CO(2)-reactivity test. In addition, we assessed autonomic modulation by means of heart rate variability and baroreflex sensitivity. We observed impaired dynamic autoregulation as shown by a multivariate analysis of variance (p<0.038) including all parameters of dCA. Similar results were found for VMR at admission (p<0.05). Pair-wise comparison between baseline and treatment with clomethiazole revealed a significant improvement for the systolic correlation coefficient index (Sx; p<0.001). Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p<0.001). In conclusion, cerebral autoregulation and VMR are disturbed during acute AWS. Influences of autonomic dysbalance and mental state during withdrawal are suggested. The finding of an affected autoregulation during acute withdrawal might indicate an increased risk for cerebro-vascular disease.
大量饮酒会增加所有主要类型中风的风险，并与酒精戒断综合征 (AWS) 期间的自主神经功能障碍有关。脑自动调节是保持脑灌注稳定的机制，代表脑循环的固有保护系统。在这里，我们旨在分析急性 AWS 对酒精依赖患者脑血流动力学的影响。我们调查了 20 名未接受药物治疗的 AWS 急性患者，并在氯美噻唑治疗开始后 24 小时重复了调查。通过动脉血压和脑血流速度 (CBFV) 波动的相关系数指数和传递函数分析（相位和增益）来评估动态脑自动调节 (dCA)。通过 CO2 反应性测试测量血管运动储备 (VMR)。此外，我们通过心率变异性和压力反射敏感性评估自主神经调节。我们观察到多元方差分析 (p<0.038) 包括 dCA 的所有参数都显示出受损的动态自动调节。入院时 VMR 的相似结果 (p<0.05)。与氯美噻唑治疗的基线和治疗之间的两两比较显示收缩压相关系数指数 (Sx) 显著改善 (p<0.001)。此外，我们发现自主神经功能障碍和自动调节受损之间存在很强的关联，这表明 LF/HF 比值与 Sx 之间存在相关性 (p<0.001)。总之，在急性 AWS 期间，脑自动调节和 VMR 受到干扰。提示在戒断期间自主神经平衡和精神状态的影响。在急性戒断期间发现自动调节受到影响可能表明脑血管疾病的风险增加。
