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透析的新冠肺炎幸存者的脑血流动力学改变：一项关于颅内压动态的经颅多普勒超声研究

Cerebral Hemodynamic Alterations in Dialysis COVID-19 Survivors: A Transcranial Doppler Ultrasound Study on Intracranial Pressure Dynamics.

作者信息

Lapeña-Motilva José, Fouz-Ruiz Daniel, Ruiz-Ortiz Mariano, Sanpedro-Murillo Eduardo, Gómez-Enjuto Sara, Hernando-Jimenez Inés, Frias-González Aida, Suso Andrea Soledad, Merida-Herrero Evangelina, Benito-León Julián

机构信息

Department of Neurology, 12 de Octubre University Hospital, Av. de Córdoba, s/n, 28041 Madrid, Spain.

Department of Neurology, Severo Ochoa University Hospital, Av. de Orellana, s/n, 28914 Leganés, Spain.

出版信息

Kidney Dial. 2025;5(2). doi: 10.3390/kidneydial5020012. Epub 2025 Apr 3.

DOI:10.3390/kidneydial5020012
PMID:40336917
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12056549/
Abstract

BACKGROUND

We observed a COVID-19 survivor with a ventriculoperitoneal shunt who developed increased intracranial pressure during hemodialysis. We hypothesized that post-SARS-CoV-2 infection, patients may have altered cerebral perfusion pressure regulation in response to intracranial pressure changes.

METHODS

From April to July 2021, we recruited dialysis patients with prior COVID-19 from two Madrid nephrology departments. We also recruited age- and sex-matched dialysis patients without prior SARS-CoV-2 infection. Transcranial Doppler ultrasound was used to measure the middle cerebral artery velocity before dialysis and 30, 60, and 90 min after the initiation of dialysis.

RESULTS

The final sample included 37 patients (16 post-COVID-19 and 21 without). The COVID-19 survivors showed a significant pulsatility index increase between 30 and 60 min compared to those without COVID-19. They also had lower heart rates.

CONCLUSIONS

We propose two mechanisms: an increase in intracranial pressure or a decreased arterial elasticity. A lower heart rate was also observed in the COVID-19 survivors. This study highlights SARS-CoV-2's multifaceted effects, including potential long-term vascular and cerebral repercussions.

摘要

背景

我们观察到一名患有脑室腹腔分流术的新冠病毒疾病（COVID-19）幸存者在血液透析期间出现颅内压升高。我们推测，在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后，患者可能会因颅内压变化而改变脑灌注压调节。

方法

2021年4月至7月，我们从马德里的两个肾脏病科招募了曾感染过COVID-19的透析患者。我们还招募了年龄和性别匹配、未曾感染过SARS-CoV-2的透析患者。使用经颅多普勒超声在透析前以及透析开始后30、60和90分钟测量大脑中动脉流速。

结果

最终样本包括37名患者（16名COVID-19康复者和21名未感染者）。与未感染COVID-19的患者相比，COVID-19康复者在30至60分钟之间的搏动指数显著增加。他们的心率也较低。

结论

我们提出了两种机制：颅内压升高或动脉弹性降低。在COVID-19康复者中还观察到心率较低。这项研究突出了SARS-CoV-2的多方面影响，包括潜在的长期血管和脑部影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/c5ea8c19f0f1/nihms-2071811-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/bf916a6a36b7/nihms-2071811-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/d31b63370257/nihms-2071811-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/00d972319b8a/nihms-2071811-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/c5ea8c19f0f1/nihms-2071811-f0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/bf916a6a36b7/nihms-2071811-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/d31b63370257/nihms-2071811-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/00d972319b8a/nihms-2071811-f0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76f/12056549/c5ea8c19f0f1/nihms-2071811-f0004.jpg

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