Pelz Johann Otto, Fischer Marie-Michéle, Bungert-Kahl Peggy, Lindner Dirk, Fricke Christopher, Michalski Dominik
Department of Neurology, University of Leipzig, Leipzig, Germany.
Neurologisches Rehabilitationszentrum Leipzig, University of Leipzig, Leipzig, Germany.
Front Neurol. 2019 Jul 3;10:720. doi: 10.3389/fneur.2019.00720. eCollection 2019.
From the variety of factors underlying the ischemia-associated edema formation in large hemispheric stroke (LHS), an increased brain water content during the early phase seems to have a pivotal role for long-lasting tissue damage. However, the importance of the fluid management during the acute phase of LHS has so far not been adequately studied. Therefore, this study explored the association between the fluid balance and functional outcome in patients suffering from LHS. We analyzed hospital-based medical records of 39 consecutive patients with LHS and decompressive hemicraniectomy. Over the first 10 days after admission, the volumes of all administered fluids were assessed daily and corrected for daily urinary output and insensible loss. Functional outcome at 3 months was assessed with the modified Rankin Scale (mRS) and dichotomized into an acceptable (mRS ≤ 4) vs. a poor outcome (mRS ≥ 5). Compared to patients with a poor functional outcome ( = 19), those with an acceptable outcome ( = 20) were characterized by a significantly lower cumulative net fluid balance at day 5 (1.6 ± 2.5 vs. 3.4 ± 4.4 l), day 7 (2.0 ± 2.9 vs. 4.6 ± 5.2 l), and day 10 (0 ± 2.5 vs. 5.6 ± 6.2 l). In addition to age, only the cumulative net fluid balance at day 10 served as an independent factor for poor functional outcome in multiple regression analyses. These data provide evidence for a critical role of the early phase net fluid balance with respect to the functional outcome after LHS. This observation leads to the hypothesis that patients with LHS might benefit from a more restrictive volume therapy. However, prospective studies are warranted to establish a causal relationship and recommendations for treatment strategies.
在导致大脑半球大面积梗死（LHS）缺血相关水肿形成的多种因素中，早期脑含水量增加似乎对持久的组织损伤起关键作用。然而，LHS急性期液体管理的重要性迄今尚未得到充分研究。因此，本研究探讨了LHS患者液体平衡与功能结局之间的关联。我们分析了39例连续行减压性颅骨切除术的LHS患者的医院病历。在入院后的前10天，每天评估所有输入液体的量，并根据每日尿量和不显性失水量进行校正。采用改良Rankin量表（mRS）评估3个月时的功能结局，并将其分为可接受结局（mRS≤4）和不良结局（mRS≥5）。与功能结局不良的患者（n = 19）相比，功能结局可接受的患者（n = 20）在第5天（1.6±2.5 vs. 3.4±4.4升）、第7天（2.0±2.9 vs. 4.6±5.2升）和第10天（0±2.5 vs. 5.6±6.2升）的累积净液体平衡显著更低。在多元回归分析中，除年龄外，仅第10天的累积净液体平衡是功能结局不良的独立因素。这些数据为LHS后早期净液体平衡对功能结局的关键作用提供了证据。这一观察结果引出一个假设，即LHS患者可能从更严格的容量治疗中获益。然而，需要前瞻性研究来建立因果关系并提出治疗策略建议。
