脑干卒中时无心肌顿抑的孤立性肺水肿

Isolated Pulmonary Edema without Myocardial Stunning in Brainstem Strokes.

作者信息

Probasco John C, Chang Tiffany, Victor David, Nyquist Paul

机构信息

Department of Neurology, Johns Hopkins School of Medicine, USA.

Department of Medicine, Johns Hopkins School of Medicine, USA.

出版信息

J Neurol Transl Neurosci. 2014;2(1):1040.

PMID:26322335

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4550320/

Abstract

INTRODUCTION

Ischemic stroke has been associated with stunned myocardium and neurogenic pulmonary edema (NPE). We studied a population of patients with large vessel brainstem ischemic stroke to see if there was an increased risk of pulmonary edema associated with strokes in this region independent of myocardial stunning.

HYPOTHESIS

Large vessel ischemic strokes of the brainstem are associated with neurogenic pulmonary edema and occur independently of myocardial stunning.

METHODS

This is a retrospective case control study of 1,278 patient admissions. Two hundred ten patients were identified with large vessel ischemic stroke or transient ischemic attack (mean age 65 years, 55% female, 50% black). Infarction locations included: brainstem (N=22), right middle cerebral artery involving the insula (N=38), left middle cerebral artery involving the insula (N=37), and transient ischemic attack (N=113). Multivariate logistic regression models for presence of echocardiographic wall motion abnormalities, QTc-interval prolongation, elevated serum troponin, and pulmonary edema were developed to examine the relative contribution of stroke location and markers of cardiopulmonary dysfunction to each respective outcome, controlling for patient characteristics.

RESULTS

Large vessel brainstem stroke was associated with pulmonary edema (adjusted OR 29.23, 95% CI 1.90-449.51) but not cardiac abnormalities. Large vessel left middle cerebral artery stroke was also associated with pulmonary edema (76.44, 6.93-843.54) as well as QTc-interval prolongation (4.55, 10.77-19.24). Large vessel right middle cerebral artery stroke was associated with pulmonary edema (10.88, 1.02-116.70) as well as elevated serum troponin (10.51, 1.71-64.82).

CONCLUSION

In a retrospective case control study, large vessel brainstem stroke was associated with the development of pulmonary edema independent of cardiac abnormalities associated with myocardial stunning, suggesting a separate brainstem pathophysiologic mechanism which directly affects the lungs but not the heart.

摘要

引言

缺血性中风与心肌顿抑和神经源性肺水肿（NPE）有关。我们研究了一组患有大血管脑干缺血性中风的患者，以观察该区域中风是否存在与心肌顿抑无关的肺水肿风险增加情况。

假设

脑干大血管缺血性中风与神经源性肺水肿有关，且独立于心肌顿抑发生。

方法

这是一项对1278例患者入院情况的回顾性病例对照研究。确定了210例患有大血管缺血性中风或短暂性脑缺血发作的患者（平均年龄65岁，55%为女性，50%为黑人）。梗死部位包括：脑干（N = 22）、累及岛叶的右侧大脑中动脉（N = 38）、累及岛叶的左侧大脑中动脉（N = 37）以及短暂性脑缺血发作（N = 113）。建立了用于评估超声心动图壁运动异常、QTc间期延长、血清肌钙蛋白升高和肺水肿情况的多因素逻辑回归模型，以检验中风部位和心肺功能障碍标志物对各相应结局的相对贡献，并对患者特征进行控制。

结果

大血管脑干中风与肺水肿有关（校正比值比29.23，95%置信区间1.90 - 449.51），但与心脏异常无关。大血管左侧大脑中动脉中风也与肺水肿有关（76.44，6.93 - 843.54）以及QTc间期延长有关（4.55，10.77 - 19.24）。大血管右侧大脑中动脉中风与肺水肿有关（10.88，1.02 - 116.70）以及血清肌钙蛋白升高有关（10.51，1.71 - 64.82）。