Jung Jae Wook, Kang Ilmo, Park Jin, Jeon Sang-Beom
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eur J Neurol. 2025 Jan;32(1):e70021. doi: 10.1111/ene.70021.
Malignant middle cerebral artery infarction (MMI) is a severe condition with a high mortality rate. While decompressive hemicraniectomy has been demonstrated to reduce mortality, there is limited knowledge regarding blood pressure (BP) management following the surgery. This study aimed to investigate whether early blood pressure variability after surgery is associated with functional outcomes.
This study was a retrospective cohort analysis of patients with MMI who underwent decompressive hemicraniectomy. We calculated BP variability (BPV) by measuring BP hourly over a 72-h period following surgery. We investigated the association between BPV parameters and functional outcomes at 3-month. Additionally, we analyzed which specific time intervals within the 72 h post-surgery BPV were associated with functional outcomes.
A total of 110 patients were eligible for analysis. The mean age was 63.1 ± 13.1 years, and 57 (51.8%) were men. Among the systolic BPV parameters, the coefficient of variance showed a significant association with functional outcomes at 3-month (adjusted odds ratio [AOR]: 0.82, 95% CI: 0.69-0.95), and this association remained significant after adjusting for the antihypertensive agents use (AOR: 0.82, 95% CI: 0.70-0.95). In contrast, diastolic BPV parameters did not show a significant association with functional outcomes. Systolic BPV during the 0- to 24-h period of the 72-h observation was significantly associated with functional outcomes (AOR: 0.87, 95% CI: 0.76-0.98).
Our study identified a significant association between systolic BPV and 3-month functional outcomes in MMI patients who underwent decompressive hemicraniectomy. This association persisted regardless of the use of antihypertensive agents, particularly during the hyperacute phase within the first 24 h post-surgery.
大脑中动脉恶性梗死（MMI）是一种严重疾病，死亡率很高。虽然减压性颅骨切除术已被证明可降低死亡率，但关于术后血压（BP）管理的知识有限。本研究旨在调查术后早期血压变异性是否与功能结局相关。
本研究是对接受减压性颅骨切除术的MMI患者进行的回顾性队列分析。我们通过在术后72小时内每小时测量血压来计算血压变异性（BPV）。我们调查了BPV参数与3个月时功能结局之间的关联。此外，我们分析了术后72小时内哪些特定时间间隔的BPV与功能结局相关。
共有110例患者符合分析条件。平均年龄为63.1±13.1岁，57例（51.8%）为男性。在收缩压BPV参数中，变异系数与3个月时的功能结局有显著关联（调整优势比[AOR]：0.82，95%置信区间[CI]：0.69-0.95），并且在调整抗高血压药物使用后这种关联仍然显著（AOR：0.82，95%CI：0.70-0.95）。相比之下，舒张压BPV参数与功能结局未显示出显著关联。72小时观察期内0至24小时的收缩压BPV与功能结局显著相关（AOR：0.87，95%CI：0.76-0.98）。
我们的研究确定了接受减压性颅骨切除术的MMI患者收缩压BPV与3个月功能结局之间存在显著关联。无论是否使用抗高血压药物，这种关联都持续存在，尤其是在术后最初24小时的超急性期。
