在早期血管痉挛前期检测到的脑自动调节功能受损与自发性蛛网膜下腔出血后的不良预后相关：一项观察性前瞻性试点研究。

Impaired cerebral autoregulation detected in early prevasospasm period is associated with unfavorable outcome after spontaneous subarachnoid hemorrhage: an observational prospective pilot study.

作者信息

Chaleckas Edvinas, Putnynaite Vilma, Lapinskiene Indre, Preiksaitis Aidanas, Serpytis Mindaugas, Rocka Saulius, Bartusis Laimonas, Petkus Vytautas, Ragauskas Arminas

机构信息

Health Telematics Science Institute, Kaunas University of Technology, K. Barsausko str. 59, Kaunas, LT-51423, Lithuania.

Clinic of Anesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

出版信息

Ultrasound J. 2024 Apr 15;16(1):24. doi: 10.1186/s13089-024-00371-8.

DOI:10.1186/s13089-024-00371-8

PMID:38619783

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11018731/

Abstract

BACKGROUND

Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes.

METHODS

The pilot observational study included 29 SAH patients whose CA status was estimated 2-3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2-3 min period were used during examinations. CA status was assessed according to the delay time (∆T) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device.

RESULTS

Statistically significant differences in ∆T were found between SAH patients with unfavorable outcomes (∆T = 1.37 ± 1.23 s) and those with favorable outcomes (∆T = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039).

CONCLUSIONS

A relatively small delay of ∆T <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.

CLINICALTRIALS

gov/study/NCT06028906 .

摘要

背景

蛛网膜下腔出血（SAH）患者在SAH后早期出现脑自动调节（CA）受损，由于延迟性脑缺血（DCI）或其他并发症，其预后不良的风险很高。关于早期CA受损与SAH患者预后之间的关联，现有证据有限。这项前瞻性研究的目的是探讨在SAH后早期快照检查中检测到的CA受损与患者预后之间的关联。

方法

这项初步观察性研究纳入了29例SAH患者，这些患者在自发性动脉瘤破裂后2 - 3天评估其CA状态，并设立了15名健康志愿者作为对照组进行比较。使用充气式腿部恢复靴（reboots.com，德国）安全地控制性产生可靠CA检查所需的动脉血压（ABP）变化。检查期间，使用腿部恢复靴进行至少5个充气 - 放气周期，周期为2 - 3分钟。根据在靴子放气周期人工诱导ABP变化期间，ABP(t)与脑血流速度（CBFV(t)）信号之间测量的延迟时间（∆T）来评估CA状态。使用经颅多普勒设备在大脑中动脉测量CBFV。