Minhas Jatinder S, Panerai Ronney B, Ghaly George, Divall Pip, Robinson Thompson G
Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
J Clin Ultrasound. 2019 Jan;47(1):14-21. doi: 10.1002/jcu.22645. Epub 2018 Sep 30.
International guidelines advocate intensive blood pressure (BP) lowering within 6 hours of acute intracerebral hemorrhage (ICH) to a target systolic BP of 130-140 mm Hg, though more intensive lowering may be associated with adverse outcome. Observational studies suggest impaired cerebral autoregulation (CA) following ICH. Transcranial Doppler ultrasonography (TCD), alongside continuous BP monitoring, provides a noninvasive bedside investigation that offers detailed perspectives on physiological perturbations post-acute ICH. This systematic review and meta-analysis focuses on all TCD studies of CA in ICH.
MEDLINE, EMBASE, and CENTRAL were searched for studies of hemorrhagic stroke and blood flow measurement.
Eight studies met inclusion criteria (293 ICH patients); CA was impaired up to 12-days post-acute ICH. Impaired CA was evidenced by reduced transfer function analysis phase and higher mean flow correlation values: these were associated with worsened clinical parameters including ICH-volume and Glasgow Coma Scale. Meta-analysis of CBV demonstrated that, compared to controls, mean CBV was significantly lower in the ipsilateral (49.7 vs 64.8 cm s , Z = 4.26, P < .0001) and contralateral hemispheres following ICH (51.5 vs 64.8 cm s , Z = 3.44, P = .0006).
Lower mean CBV in combination with impaired CA may have implications for more intensive BP lowering and warrants further studies examining such strategies on cerebral blood flow and its regulatory mechanisms.
国际指南提倡在急性脑出血（ICH）6小时内将血压（BP）强化降低至收缩压目标值130 - 140 mmHg，尽管更强化的降压可能与不良结局相关。观察性研究提示ICH后存在脑自动调节（CA）受损。经颅多普勒超声检查（TCD）与连续血压监测一起，提供了一种无创的床边检查方法，能详细观察急性ICH后生理紊乱情况。本系统评价和荟萃分析聚焦于所有关于ICH中CA的TCD研究。
检索MEDLINE、EMBASE和CENTRAL数据库以查找出血性卒中及血流测量的研究。
八项研究符合纳入标准（293例ICH患者）；急性ICH后长达12天CA均受损。CA受损表现为传递函数分析相位降低和平均血流相关值升高：这些与包括ICH体积和格拉斯哥昏迷量表在内的临床参数恶化相关。CBV的荟萃分析表明，与对照组相比，ICH后同侧半球平均CBV显著降低（49.7对64.8 cm/s，Z = 4.26，P <.0001），对侧半球也降低（51.5对64.8 cm/s，Z = 3.44，P =.0006）。
平均CBV降低与CA受损相结合可能对更强化的血压降低有影响，值得进一步研究此类策略对脑血流及其调节机制的作用。
