Khatibi Kasra, Szeder Viktor, Blanco Manuel Buitrago, Tateshima Satoshi, Jahan Reza, Duckwiler Gary, Vespa Paul
Division of Neurocritical Care, Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA.
Acta Neurochir Suppl. 2020;127:141-144. doi: 10.1007/978-3-030-04615-6_20.
Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI.
All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO, lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm.
A total of ten patients with aSAH who underwent MMM were identified. PbtO decline correlates with severity of proximal vasospasm (r = -0.66). PbtO was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different.
Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO and CMD help in real-time detection and management of DCI.
对于临床检查结果不佳的动脉瘤性蛛网膜下腔出血（aSAH）患者，检测迟发性脑缺血（DCI）具有挑战性。脑组织氧分压监测（PbtO）和脑微透析（CMD）可检测缺血和代谢紊乱。我们的目的是评估这些方法在实时检测DCI中的疗效。
对2013年至2015年间在我们机构接受PbtO和/或CMD多模态监测（MMM）的所有aSAH患者进行回顾性研究。在每次用于评估和治疗血管痉挛的血管造影前24小时内，平均PbtO、乳酸与丙酮酸比值（LPR）和葡萄糖与监测器所在半球观察到的血管痉挛程度相关。还比较了在存在和不存在血管造影显著血管痉挛情况下的平均测量值。
共确定了10例接受MMM的aSAH患者。PbtO下降与近端血管痉挛的严重程度相关（r = -0.66）。在血管痉挛情况下，PbtO显著更低（17.6对25.8，p = 0.003），但LPR（34.5对26.8，p = 0.1）和葡萄糖（0.8对1.1，p = 0.6）无显著差异。
aSAH后的近端血管痉挛与组织缺血和/或代谢紊乱的MMM指标相关。PbtO和CMD有助于DCI的实时检测和管理。
