Kevci Rozerin, Hånell Anders, Howells Timothy, Fahlström Andreas, Lewén Anders, Enblad Per, Svedung Wettervik Teodor
J Neurosurg. 2025 Feb 21;143(1):255-265. doi: 10.3171/2024.10.JNS241038. Print 2025 Jul 1.
There is a paucity of studies on the optimal thresholds for neurointensive care (NIC) targets such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in spontaneous intracerebral hemorrhage (sICH). There is also a need to clarify the role of cerebral pressure autoregulatory disturbances (pressure reactivity index [PRx]) and to determine if the autoregulatory CPP target (optimal CPP [CPPopt]) is superior to traditional fixed CPP targets in sICH. In this study, the authors aimed to explore the role of ICP, PRx, CPP, and CPPopt insults in sICH patients treated in the NIC unit.
In this observational study, 184 adults with sICH with intracerebral hemorrhage (ICH) volume above 10 ml who received > 12 hours of ICP monitoring during the first 7 days at the authors' NIC unit, Uppsala University Hospital, Sweden, between 2010 and 2019 (10 years) were included. Demographic characteristics, admission status, radiological examination, and clinical outcome were evaluated. Favorable outcome was defined as conscious at discharge, while unfavorable outcome as unconscious or deceased. ICP, CPP, PRx, and CPPopt during the first 7 days were analyzed in relation to outcome.
In total, 138 (75%) patients recovered favorably at discharge. Lower percentage of good monitoring time with ICP above 25 mm Hg was independently associated with favorable outcome. CPP above 80 mm Hg was frequent and independently associated with favorable outcome. Median PRx did not differ between the outcome groups, but there was a trend toward worse outcome when PRx exceeded +0.5. Furthermore, when PRx was analyzed together with the concurrent ICP and CPP values, higher values increased the ICP and CPP interval associated with unfavorable outcome. Lastly, there was no independent correlation between CPP deviation from CPPopt and outcome.
Avoiding ICP elevations above 20 to 25 mm Hg and maintaining CPP above 80 mm Hg may be beneficial in sICH patients with large bleeding volume who require NIC. PRx was not independently associated with outcome, but higher values appeared to narrow the safe zones of ICP and CPP.
关于自发性脑出血（sICH）患者神经重症监护（NIC）目标（如颅内压（ICP）和脑灌注压（CPP））的最佳阈值的研究较少。还需要阐明脑压力自动调节障碍（压力反应性指数[PRx]）的作用，并确定自动调节的CPP目标（最佳CPP[CPPopt]）在sICH中是否优于传统的固定CPP目标。在本研究中，作者旨在探讨ICP、PRx、CPP和CPPopt损伤在NIC病房治疗的sICH患者中的作用。
在这项观察性研究中，纳入了2010年至2019年（10年）期间在瑞典乌普萨拉大学医院作者的NIC病房接受治疗、脑出血（ICH）体积超过10 ml且在最初7天内接受了超过12小时ICP监测的184例成年sICH患者。评估了人口统计学特征、入院状态、放射学检查和临床结局。良好结局定义为出院时清醒，不良结局定义为昏迷或死亡。分析了最初7天内的ICP、CPP、PRx和CPPopt与结局的关系。
共有138例（75%）患者出院时预后良好。ICP高于25 mmHg时良好监测时间的百分比更低与良好结局独立相关。CPP高于80 mmHg很常见且与良好结局独立相关。两组结局的PRx中位数无差异，但当PRx超过+0.5时，有预后较差的趋势。此外，当将PRx与同时的ICP和CPP值一起分析时，较高的值增加了与不良结局相关的ICP和CPP区间。最后，CPP与CPPopt的偏差与结局之间无独立相关性。
对于需要NIC的大出血量sICH患者，避免ICP升高超过20至25 mmHg并将CPP维持在80 mmHg以上可能有益。PRx与结局无独立相关性，但较高的值似乎会缩小ICP和CPP的安全范围。
