Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Adult Critical Care Unit, Hospital Cristo Redentor, Rua Domingos Rubbo, 20, Porto Alegre, Rio Grande do Sul, CEP: 91040-000, Brazil.
Neurocrit Care. 2019 Oct;31(2):253-262. doi: 10.1007/s12028-019-00732-5.
Cerebral autoregulation (CA) impairment after aneurysmal subarachnoid hemorrhage (SAH) has been associated with delayed cerebral ischemia and an unfavorable outcome. We investigated whether the early transient hyperemic response test (THRT), a transcranial Doppler (TCD)-based CA evaluation method, can predict functional outcome 6 months after aneurysmal SAH.
This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between January 2016 and February 2017. CA was evaluated within 72 h of hemorrhage by THRT, which describes the changes in cerebral blood flow velocity after a brief compression of the ipsilateral common carotid artery. CA was considered to be preserved when an increase ≥ 9% of baseline systolic velocity was present. According to the modified Rankin Scale (mRS: 4-6), the primary outcome was unfavorable 6 months after hemorrhage. Secondary outcomes included cerebral infarction, vasospasm on TCD, and an unfavorable outcome at hospital discharge.
Forty patients were included (mean age = 54 ± 12 years, 70% females). CA was impaired in 19 patients (47.5%) and preserved in 21 (52.5%). Impaired CA patients were older (59 ± 13 vs. 50 ± 9, p = 0.012), showed worse neurological conditions (Hunt&Hess 4 or 5-47.4% vs. 9.5%, p = 0.012), and clinical initial condition (APACHE II physiological score-12 [5.57-13] vs. 3.5 [3-5], p = 0.001). Fourteen patients in the impaired CA group and one patient in the preserved CA group progressed to an unfavorable outcome (73.7% vs. 4.7%, p = 0.0001). The impaired CA group more frequently developed cerebral infarction than the preserved CA group (36.8% vs. 0%, p = 0.003, respectively). After multivariate analysis, impaired CA (OR 5.15 95% CI 1.43-51.99, p = 0.033) and the APACHE II physiological score (OR 1.67, 95% CI 1.01-2.76, p = 0.046) were independently associated with an unfavorable outcome.
Early CA impairment detected by TCD and admission APACHE II physiological score independently predicted an unfavorable outcome after SAH.
蛛网膜下腔出血（SAH）后大脑自动调节（CA）受损与迟发性脑缺血和不良预后有关。我们研究了经颅多普勒（TCD）为基础的 CA 评估方法-早期短暂性充血反应测试（THRT）是否可以预测 SAH 后 6 个月的功能结局。
这是一项对 2016 年 1 月至 2017 年 2 月期间连续入住单一中心的所有 SAH 患者的前瞻性观察性研究。通过 THRT 在出血后 72 小时内评估 CA，该方法描述了短暂压迫同侧颈总动脉后脑血流速度的变化。当收缩期速度基线增加≥9%时，认为 CA 得到了保留。根据改良 Rankin 量表（mRS：4-6），主要结局为出血后 6 个月不良。次要结局包括脑梗死、TCD 血管痉挛和出院时不良结局。
共纳入 40 例患者（平均年龄 54±12 岁，70%为女性）。19 例（47.5%）患者 CA 受损，21 例（52.5%）患者 CA 正常。CA 受损的患者年龄较大（59±13 岁 vs. 50±9 岁，p=0.012），神经功能状态更差（Hunt&Hess 4 或 5-47.4% vs. 9.5%，p=0.012），临床初始状况（急性生理学和慢性健康评估 II 生理评分-12 [5.57-13] vs. 3.5 [3-5]，p=0.001）。在受损 CA 组中有 14 例患者和在正常 CA 组中有 1 例患者进展为不良结局（73.7% vs. 4.7%，p=0.0001）。与正常 CA 组相比，受损 CA 组更常发生脑梗死（36.8% vs. 0%，p=0.003）。多变量分析后，受损 CA（OR 5.15，95%CI 1.43-51.99，p=0.033）和急性生理学和慢性健康评估 II 生理评分（OR 1.67，95%CI 1.01-2.76，p=0.046）与不良结局独立相关。
TCD 检测到的早期 CA 受损和入院时急性生理学和慢性健康评估 II 生理评分独立预测了 SAH 后的不良结局。
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