Department of Neurosurgery, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Japan.
Acta Neurochir (Wien). 2012 Dec;154(12):2195-202. doi: 10.1007/s00701-012-1491-1. Epub 2012 Sep 13.
Cardiopulmonary complications are common after subarachnoid hemorrhage (SAH), and include pulmonary edema (PE). The purpose of this study was to investigate circulatory characteristics of normovolemia and normotension therapy after SAH using pulse contour analysis, and to reveal the mechanisms of PE after SAH.
Pulse contour analysis was performed from day 3 until day 12 after the onset of SAH in 49 patients.
Global end-diastolic volume index (GEDI) was normal, although net water balance was estimated to be negative and central venous pressure (CVP) was low in all patients. Seven patients (14 %) suffered from pulmonary edema. Cardiac function index (CFI) and global ejection fraction (GEF) were lower in patients with pulmonary edema (PE group) than in patients without PE (non-PE group) throughout the study period (CFI, P≤0.0119; GEF, P≤0.0348). The PE group showed higher GEDI from days 7 to 10, and higher extravascular lung water index (ELWI) throughout the entire study period compared to the non-PE group (GEDI, P≤0.0094; ELWI, P≤0.0077).
The appropriate preload was kept despite negative net water balance and low CVP. PE after SAH was biphasic, with cardiogenic PE caused by low cardiac contractility immediately after SAH, and hydrostatic PE caused by low cardiac contractility and hypervolemia on and after day 7 of SAH. Pulse contour analysis was useful to monitor this unique circulatory change and effective for detecting cardiopulmonary complications after SAH.
蛛网膜下腔出血（SAH）后常发生心肺并发症，包括肺水肿（PE）。本研究旨在通过脉搏轮廓分析研究 SAH 后正常血容量和正常血压治疗的循环特征，并揭示 SAH 后 PE 的机制。
对 49 例 SAH 发病后第 3 天至第 12 天的患者进行脉搏轮廓分析。
所有患者的净液体平衡估计为负，中心静脉压（CVP）低，但整体舒张末期容积指数（GEDI）正常。7 例（14%）患者发生肺水肿。在整个研究期间，患有肺水肿（PE 组）的患者的心脏功能指数（CFI）和整体射血分数（GEF）均低于未患有肺水肿的患者（非 PE 组）（CFI，P≤0.0119；GEF，P≤0.0348）。PE 组从第 7 天到第 10 天的 GEDI 较高，整个研究期间的血管外肺水指数（ELWI）较高（GEDI，P≤0.0094；ELWI，P≤0.0077）。
尽管存在负净液体平衡和低 CVP，但仍保持适当的前负荷。SAH 后 PE 呈双相性，SAH 后即刻因心脏收缩力降低导致心源性 PE，SAH 后第 7 天及以后因心脏收缩力降低和血容量增加导致静水 PE。脉搏轮廓分析有助于监测这种独特的循环变化，并有效检测 SAH 后的心肺并发症。
