前瞻性研究观察在介入放射学套房中脑血管造影对定量瞳孔计值的影响。
Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite.
机构信息
Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
出版信息
BMJ Open. 2024 Feb 29;14(2):e080779. doi: 10.1136/bmjopen-2023-080779.
OBJECTIVES
The purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an independent predictor of change in pupillary light reflex (PLR) metrics.
DESIGN
This was a prospective, observational pilot study of PLR assessments obtained using QP 30 min before and after DCA. All patients had QP measurements performed with the NPi-300 (Neuroptics) pupillometer.
SETTING
Recruitment was done at a single-centre, tertiary-care academic hospital and comprehensive stroke centre in Dallas, Texas.
PARTICIPANTS
Fifty participants were recruited undergoing elective or emergent angiography. Inclusion criteria were a physician-ordered interventional neuroradiological procedure, at least 18 years of age, no contraindications to PLR assessment with QP, and nursing transport to and from DCA. Patients with a history of eye surgery were excluded.
MAIN OUTCOME MEASURES
Difference in PLR metric obtained from QP 30 min before and after DCA.
RESULTS
Statistically significant difference was noted in the pre and post left eye readings for the minimum pupil size (a.k.a., pupil diameter on maximum constriction). The mean maximum constriction diameter prior to angiogram of 3.2 (1.1) mm was statistically larger than after angiogram (2.9 (1.0) mm; p<0.05); however, this was not considered clinically significant. Comparisons for all other PLR metrics pre and post angiogram demonstrated no significant difference. Using change in NPi pre and post angiogram (Δpre=0.05 (0.77) vs Δpost=0.08 (0.67); p=0.62), we calculated the effect size as 0.042. Hence, detecting a statistically significant difference in NPi, if a difference exists, would require a sample size of ~6000 patients.
CONCLUSIONS
Our study provides supportive data that in an uncomplicated angiogram, even with intervention, there is no effect on the PLR.
目的
本初步研究旨在获取经导管脑血管造影（DCA）前后的瞳孔测量学（QP）基线定量数据，以探索以下假说，即脑血管造影是瞳孔光反射（PLR）测量值变化的独立预测因子。
设计
这是一项前瞻性、观察性初步研究，使用 QP 在 DCA 前后 30 分钟时评估 PLR。所有患者均使用 NPi-300（Neuroptics）瞳孔计进行 QP 测量。
地点
德克萨斯州达拉斯的一家单中心三级保健学术医院和综合卒中中心进行了招募。
参与者
共招募了 50 名接受择期或紧急血管造影的患者。纳入标准为医生要求的介入性神经放射学程序，年龄至少 18 岁，无 QP 评估 PLR 的禁忌症，且能够在 DCA 期间进行护理转运。既往有眼部手术史的患者被排除在外。
主要观察指标
DCA 前后 30 分钟时 PLR 测量值的差异。
结果
左眼前、后读数的最小瞳孔大小（亦称最大收缩时的瞳孔直径）有统计学显著差异。血管造影前平均最大收缩直径为 3.2（1.1）mm，明显大于血管造影后（2.9（1.0）mm；p<0.05）；然而，这并不被认为具有临床意义。血管造影前后的所有其他 PLR 测量值的比较均无显著差异。血管造影前后 NPi 的变化（Δpre=0.05（0.77）vs Δpost=0.08（0.67）；p=0.62），我们计算的效应大小为 0.042。因此，如果存在差异，要检测到 NPi 上的统计学显著差异，需要大约 6000 名患者的样本量。
结论
我们的研究提供了支持性数据，表明在不复杂的血管造影中，即使进行了干预，PLR 也不会受到影响。
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