Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa; Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
Am J Obstet Gynecol. 2021 Aug;225(2):185.e1-185.e9. doi: 10.1016/j.ajog.2021.03.017. Epub 2021 Mar 17.
Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear.
This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women.
This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups.
We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] and 80.0 mm Hg [interquartile range, 67.5-92.0], respectively); furthermore, there was no difference in cerebral perfusion pressure between pregnant women with eclampsia and pregnant women with preeclampsia with severe features (109.5 mm Hg [interquartile range, 91.2-130.9] vs 96.5 mm Hg [interquartile range, 75.8-110.5]).
Cerebral perfusion pressure and dynamic cerebral autoregulation are altered in eclampsia and may be important in the pathophysiological pathway and constitute a therapeutic target in the prevention of cerebral complications in preeclampsia.
与正常妊娠相比，子痫前期孕妇的动态脑自动调节和脑灌注压发生改变，但子痫前期孕妇中动态脑自动调节、脑灌注压和脑并发症之间的联系尚不清楚。
本研究旨在评估子痫、子痫伴有严重特征和无严重特征以及正常血压孕妇产后的动态脑自动调节和脑灌注压。
这是南非开普敦一家大型转诊医院的前瞻性病例对照研究。在诊断时（病例）或分娩时（对照组）招募参与者。对病例和对照组进行经颅多普勒检查，同时进行连续无创血压测量和呼气末 CO 监测。计算脑灌注压和动态脑自动调节指数，并比较各组之间的数值。
我们纳入了 16 例子痫患者、18 例子痫伴有严重特征患者、32 例子痫无严重特征患者和 21 例正常血压无并发症孕妇。与其他所有组（子痫伴有严重特征患者的自动调节指数为 5.6[四分位距为 4.4-6.8]、子痫无严重特征患者的自动调节指数为 6.8[四分位距为 5.1-7.4]和正常血压对照组的自动调节指数为 7.1[四分位距为 6.1-7.9]相比，子痫患者的动态脑自动调节受损（自动调节指数为 3.9，四分位距为 3.1-5.2）。子痫患者的脑灌注压升高（109.5mmHg，四分位距为 91.2-130.9），高于子痫无严重特征患者和正常血压患者（84mmHg，四分位距为 73.0-122.0 和 80.0mmHg，四分位距为 67.5-92.0）；此外，子痫患者与子痫伴有严重特征患者的脑灌注压无差异（109.5mmHg，四分位距为 91.2-130.9 vs 96.5mmHg，四分位距为 75.8-110.5）。
子痫中脑灌注压和动态脑自动调节发生改变，这可能是子痫前期病理生理途径中的重要因素，并构成预防子痫前期脑并发症的治疗靶点。
