Neuroscience Institute, The Queen's Medical Center, Honolulu, Hawaii, USA.
BMC Neurol. 2011 Aug 31;11:108. doi: 10.1186/1471-2377-11-108.
Dynamic cerebral autoregulation after intracerebral hemorrhage (ICH) remains poorly understood. We performed a case-control study to compare dynamic autoregulation between ICH patients and healthy controls.
Twenty-one patients (66 ± 15 years) with early (< 72 hours) lobar or basal ganglia ICH were prospectively studied and compared to twenty-three age-matched controls (65 ± 9 years). Continuous measures of mean flow velocity (MFV) in the middle cerebral artery and mean arterial blood pressure (MAP) were obtained over 5 min. Cerebrovascular resistance index (CVRi) was calculated as the ratio of MAP to MFV. Dynamic cerebral autoregulation was assessed using transfer function analysis of spontaneous MAP and MFV oscillations in the low (0.03-0.15 Hz) and high (0.15-0.5 Hz) frequency ranges.
The ICH group demonstrated higher CVRi compared to controls (ipsilateral: 1.91 ± 1.01 mmHg·s·cm-1, p = 0.04; contralateral: 2.01 ± 1.24 mmHg·s·cm-1, p = 0.04; vs. control: 1.42 ± 0.45 mmHg·s·cm-1). The ICH group had higher gains than controls in the low (ipsilateral: 1.33 ± 0.58%/mmHg, p = 0.0005; contralateral: 1.47 ± 0.98%/mmHg, p = 0.004; vs. control: 0.82 ± 0.30%/mmHg) and high (ipsilateral: 2.11 ± 1.31%/mmHg, p < 0.0001; contralateral: 2.14 ± 1.49%/mmHg, p < 0.0001; vs. control: 0.66 ± 0.26%/mmHg) frequency ranges. The ICH group also had higher coherence in the contralateral hemisphere than the control (ICH contralateral: 0.53 ± 0.38, p = 0.02; vs. control: 0.38 ± 0.15) in the high frequency range.
Patients with ICH had higher gains in a wide range of frequency ranges compared to controls. These findings suggest that dynamic cerebral autoregulation may be less effective in the early days after ICH. Further study is needed to determine the relationship between hematoma size and severity of autoregulation impairment.
脑出血（ICH）后动态脑自动调节仍知之甚少。我们进行了一项病例对照研究，以比较 ICH 患者和健康对照者之间的自动调节。
前瞻性研究了 21 例（66 ± 15 岁）早期（<72 小时）额叶或基底节 ICH 患者，并与 23 例年龄匹配的对照组（65 ± 9 岁）进行了比较。连续测量大脑中动脉的平均血流速度（MFV）和平均动脉血压（MAP）5 分钟。脑血管阻力指数（CVRi）计算为 MAP 与 MFV 的比值。使用低频（0.03-0.15 Hz）和高频（0.15-0.5 Hz）范围的自发 MAP 和 MFV 振荡的传递函数分析评估动态脑自动调节。
ICH 组与对照组相比，CVRi 更高（同侧：1.91 ± 1.01 mmHg·s·cm-1，p = 0.04；对侧：2.01 ± 1.24 mmHg·s·cm-1，p = 0.04；与对照组相比：1.42 ± 0.45 mmHg·s·cm-1）。ICH 组的低频（同侧：1.33 ± 0.58%/mmHg，p = 0.0005；对侧：1.47 ± 0.98%/mmHg，p = 0.004；与对照组相比：0.82 ± 0.30%/mmHg）和高频（同侧：2.11 ± 1.31%/mmHg，p <0.0001；对侧：2.14 ± 1.49%/mmHg，p <0.0001；与对照组相比：0.66 ± 0.26%/mmHg）增益均高于对照组。ICH 组对侧半球的相干性也高于对照组（ICH 对侧：0.53 ± 0.38，p = 0.02；与对照组相比：0.38 ± 0.15）在高频范围内。
与对照组相比，ICH 患者在较宽的频率范围内具有更高的增益。这些发现表明，ICH 后早期的脑自动调节可能效果较差。需要进一步研究血肿大小与自动调节损伤严重程度之间的关系。
