Uryga Agnieszka, Nasr Nathalie, Kasprowicz Magdalena, Budohoski Karol, Sykora Marek, Smielewski Peter, Burzyńska Małgorzata, Czosnyka Marek
Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wrocław, Poland.
INSERM UMR 1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.
Front Neurol. 2022 Jan 12;12:740338. doi: 10.3389/fneur.2021.740338. eCollection 2021.
Common consequences following aneurysmal subarachnoid hemorrhage (aSAH) are cerebral vasospasm (CV), impaired cerebral autoregulation (CA), and disturbance in the autonomic nervous system, as indicated by lower baroreflex sensitivity (BRS). The compensatory interaction between BRS and CA has been shown in healthy volunteers and stable pathological conditions such as carotid atherosclerosis. The aim of this study was to investigate whether the inverse correlation between BRS and CA would be lost in patients after aSAH during vasospasm. A secondary objective was to analyze the time-trend of BRS after aSAH. Retrospective analysis of prospectively collected data was performed at the Neuro-Critical Care Unit of Addenbrooke's Hospital (Cambridge, UK) between June 2010 and January 2012. The cerebral blood flow velocity (CBFV) was measured in the middle cerebral artery using transcranial Doppler ultrasonography (TCD). The arterial blood pressure (ABP) was monitored invasively through an arterial line. CA was quantified by the correlation coefficient (Mxa) between slow oscillations in ABP and CBFV. BRS was calculated using the sequential cross-correlation method using the ABP signal. A total of 73 patients with aSAH were included. The age [median (lower-upper quartile)] was 58 (50-67). WFNS scale was 2 (1-4) and the modified Fisher scale was 3 (1-3). In the total group, 31 patients (42%) had a CV and 42 (58%) had no CV. ABP and CBFV were higher in patients with CV during vasospasm compared to patients without CV ( = 0.001 and < 0.001). There was no significant correlation between Mxa and BRS in patients with CV, neither during nor before vasospasm. In patients without CV, a significant, although moderate correlation was found between BRS and Mxa (r = 0.31; = 0.040), with higher BRS being associated with worse CA. Multiple linear regression analysis showed a significant worsening of BRS after aSAH in patients with CV ( = -0.42; < 0.001). Inverse compensatory correlation between BRS and CA was lost in patients who developed CV after aSAH, both before and during vasospasm. The impact of these findings on the prognosis of aSAH should be investigated in larger studies.
动脉瘤性蛛网膜下腔出血（aSAH）后的常见后果包括脑血管痉挛（CV）、脑自动调节功能受损（CA）以及自主神经系统紊乱，表现为压力反射敏感性（BRS）降低。在健康志愿者和颈动脉粥样硬化等稳定病理状态下，已证实BRS与CA之间存在代偿性相互作用。本研究的目的是调查aSAH患者在血管痉挛期间BRS与CA之间的负相关关系是否会消失。第二个目标是分析aSAH后BRS的时间趋势。对2010年6月至2012年1月在英国剑桥阿登布鲁克医院神经重症监护病房前瞻性收集的数据进行回顾性分析。使用经颅多普勒超声（TCD）测量大脑中动脉的脑血流速度（CBFV）。通过动脉导管有创监测动脉血压（ABP）。CA通过ABP和CBFV慢振荡之间的相关系数（Mxa）进行量化。使用ABP信号通过序列互相关法计算BRS。共纳入73例aSAH患者。年龄[中位数（下四分位数 - 上四分位数）]为58（50 - 67）。世界神经外科联盟（WFNS）分级为2（1 - 4），改良Fisher分级为3（1 - 3）。在整个研究组中，31例患者（42%）发生CV，42例（58%）未发生CV。血管痉挛期间发生CV的患者与未发生CV的患者相比，ABP和CBFV更高（分别为P = 0.001和P < 0.001）。发生CV的患者在血管痉挛期间及之前，Mxa与BRS之间均无显著相关性。在未发生CV的患者中，发现BRS与Mxa之间存在显著但中等程度的相关性（r = 0.31；P = 0.040），BRS越高，CA越差。多元线性回归分析显示，发生CV的aSAH患者在aSAH后BRS显著恶化（β = -0.42；P < 0.001）。aSAH后发生CV的患者在血管痉挛之前和期间，BRS与CA之间的反向代偿相关性均消失。这些发现对aSAH预后的影响应在更大规模的研究中进行调查。
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