Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Department of Operative Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany.
Neurocrit Care. 2018 Oct;29(2):214-224. doi: 10.1007/s12028-018-0528-6.
Spontaneous blood pressure increase is frequently observed after aneurysmal subarachnoid hemorrhage (aSAH). These episodes of spontaneous blood pressure alterations are usually tolerated under the assumption of an endogenous response to maintain cerebral perfusion. The relevance of blood pressure variability and its relationship to disease severity and outcome, however, remain obscure.
A total of 115 consecutive patients with aSAH were included for this retrospective analysis of a continuously collected data pool. Demographics, initial clinical severity of aSAH (HH°, mFS), treatment modality, clinical course, and outcome (development of DCI, cerebral infarction, and GOS after 3 months) were recorded. Hemodynamic information-recorded automatically with a frequency of 1/15 min-was analyzed for spontaneous blood pressure increase (SBI) and endogenous persistent hypertension (EPH) after exclusion of iatrogenic factors and relevant co-medication. Subgroup analysis included stratification for day 0-3, 4-14, and 14-21.
SBI and EPH incidence varied from 17 to 84% depending on detection threshold (15-35 mmHg) and time period under scrutiny. Incidence of blood pressure increase correlated with disease severity upon admission (p < 0.05), but the anticipated association with outcome was not observed. SBI and EPH were more likely to occur between day 4 and 14 (p < 0.001), but only early occurrence (day 0-3) was associated with higher incidence of DCI (p < 0.05). Persistent blood pressure elevation between day 4 and 21 was associated with fewer DCI. However, no influence of spontaneous upregulation on clinical outcome after three months was observed.
Spontaneous hemodynamic upregulation is a frequent phenomenon after aSAH. Our data support the hypothesis that spontaneous blood pressure alterations reflect an endogenous, demand-driven response correlating with disease severity. Early alterations may indicate an aggravated clinical course, while later upregulation in particular-if permitted-does not translate into a higher risk of unfavorable outcome.
自发性血压升高在蛛网膜下腔出血（aSAH）后经常发生。这些自发性血压变化的发作通常被认为是维持脑灌注的内源性反应而被耐受。然而，血压变异性的相关性及其与疾病严重程度和结局的关系仍不清楚。
对连续收集的数据池进行回顾性分析，共纳入 115 例连续 aSAH 患者。记录人口统计学资料、初始临床严重程度（HH°，mFS）、治疗方式、临床过程和结局（3 个月后出现 DCI、脑梗死和 GOS）。使用 1/15 分钟的频率自动记录血流动力学信息，排除医源性因素和相关合并用药后，分析自发性血压升高（SBI）和内源性持续高血压（EPH）。亚组分析包括 0-3 天、4-14 天和 14-21 天的分层。
根据检测阈值（15-35mmHg）和检测时间段，SBI 和 EPH 的发生率在 17%至 84%之间变化。血压升高的发生率与入院时的疾病严重程度相关（p<0.05），但与结局的预期关联未观察到。SBI 和 EPH 更可能发生在第 4 天至第 14 天（p<0.001），但只有早期发生（第 0-3 天）与更高的 DCI 发生率相关（p<0.05）。第 4 天至第 21 天持续血压升高与更少的 DCI 相关。然而，自发性血压升高对三个月后的临床结局没有影响。
蛛网膜下腔出血后自主血流动力学调节是一种常见现象。我们的数据支持这样一种假设，即自发性血压变化反映了一种内源性、需求驱动的反应，与疾病严重程度相关。早期的变化可能表明临床过程加重，而晚期的上调（如果允许的话）并不意味着不良结局的风险增加。
