蛛网膜下腔出血后使用血管升压药输注不会增加局部脑组织氧合。

Vasopressor Infusion After Subarachnoid Hemorrhage Does Not Increase Regional Cerebral Tissue Oxygenation.

作者信息

Yousef Khalil M, Crago Elizabeth, Chang Yuefang, Lagattuta Theodore F, Mahmoud Khadejah, Shutter Lori, Balzer Jeffrey R, Pinsky Michael R, Friedlander Robert M, Hravnak Marilyn

机构信息

Elizabeth Crago, PhD RN, School of Nursing, University of Pittsburgh, Pittsburgh, PA. Yuefang Chang, PhD, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Theodore F. Lagattuta, RN, School of Nursing, University of Pittsburgh, Pittsburgh, PA. Khadejah Mahmoud, BSN RN, School of Nursing, University of Pittsburgh, Pittsburgh, PA. Lori Shutter, MD, University of Pittsburgh School of Medicine, and Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. Jeffrey R. Balzer, PhD, School of Nursing, University of Pittsburgh, and Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Michael R. Pinsky, MD CM DrHC, University of Pittsburgh School of Medicine, and Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. Robert M. Friedlander, MD, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Marilyn Hravnak, PhD RN ACNP-BC FCCM FAAN, School of Nursing, University of Pittsburgh, Pittsburgh, PA.

出版信息

J Neurosci Nurs. 2018 Aug;50(4):225-230. doi: 10.1097/JNN.0000000000000382.

DOI:10.1097/JNN.0000000000000382

PMID:29985275

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6044455/

Abstract

INTRODUCTION

Vasopressors are commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to sustain cerebral pressure gradients. Yet, the relationship between vasopressors and the degree of cerebral microcirculatory support achieved remains unclear. This study aimed to explore the changes in cerebral and peripheral regional tissue oxygen saturation (rSO2) as well as blood pressure (BP) before and after vasopressor infusion in patients with aSAH.

METHODS

Continuous noninvasive cerebral and peripheral rSO2 was obtained using near-infrared spectroscopy for up to 14 days after aSAH. Within-subject differences in rSO2 before and after the commencement of vasopressor infusion were analyzed controlling for Hunt and Hess grade and vasospasm.

RESULTS

Of 45 patients with continuous rSO2 monitoring, 19 (42%) received vasopressor infusion (all 19 on norepinephrine, plus epinephrine in 2 patients, phenylephrine in 4 patients, and vasopressin in 2 patients). In these 19 patients, their vasopressor infusion times were associated with higher BP (systolic [b = 15.1], diastolic [b = 7.3], and mean [b = 10.1]; P = .001) but lower cerebral rSO2 (left cerebral rSO2 decreased by 4.4% [b = -4.4, P < .0001]; right cerebral rSO2 decreased by 5.5% [b = -5.5, P = .0002]).

CONCLUSIONS

Despite elevation in systemic BP during vasopressor infusion times, cerebral rSO2 was concurrently diminished. These findings warrant further investigation for the effect of induced hypertension on cerebral microcirculation.

摘要

引言

动脉瘤性蛛网膜下腔出血（aSAH）后常用血管升压药来维持脑压梯度。然而，血管升压药与所实现的脑微循环支持程度之间的关系仍不清楚。本研究旨在探讨aSAH患者在输注血管升压药前后脑和外周局部组织氧饱和度（rSO2）以及血压（BP）的变化。

方法

在aSAH后长达14天的时间里，使用近红外光谱法连续无创地获取脑和外周的rSO2。分析血管升压药输注开始前后rSO2的受试者内差异，并对Hunt和Hess分级以及血管痉挛进行控制。

结果

在45例连续监测rSO2的患者中，19例（42%）接受了血管升压药输注（全部19例使用去甲肾上腺素，2例加用肾上腺素，4例加用去氧肾上腺素，2例加用血管加压素）。在这19例患者中，他们的血管升压药输注时间与较高的血压相关（收缩压[b = 15.1]、舒张压[b = 7.3]和平均压[b = 10.1]；P = .001），但与较低的脑rSO2相关（左脑rSO2下降4.4%[b = -4.4，P < .0001]；右脑rSO2下降5.5%[b = -5.5，P = .0002]）。