Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries
Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries
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DOI：
10.1016/j.wneu.2016.08.053
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发表时间：
2016-12-01
影响因子：
2
通讯作者：
Manley, Geoffrey
中科院分区：
文献类型：
--
作者：
Catapano, Joshua Stephen;Hawryluk, Gregory William John;Manley, Geoffrey
背景：外伤性脊髓损伤（SCI）指南建议在脊髓损伤后7天内保持平均动脉压（MAPs）高于85毫米汞柱，以减少脊髓缺血。一些医生怀疑最初完全受伤的病人是否能从中受益。目的：评估按美国脊髓损伤协会损伤量表（AIS）初始评分分层的脊髓损伤患者MAP增强与神经功能改善之间的关系。方法：记录6年内入院的急性SCI患者的高频MAP值，并通过复苏后AIS评分分层分析，将这些值与神经系统恢复程度相关。结果：对62例脊髓损伤患者进行了分析。33例患者被确定为完全损伤，其中11例在出院时至少改善了1级AIS。初始AIS A患者改善与未改善的平均MAP显著增高（分别为96.6 +/- 0.07 mm Hg vs. 94.4 +/- 0.06 mm Hg, P < 0.001）， MAP值< 85 mm Hg的比例显著降低（分别为13.5% vs. 25.6%, P < 0.001）。在AIS B和C患者中，MAP值与预后之间也存在正相关，而在初始AIS D患者中则没有。结论：AIS A、B和C患者的MAP值与神经功能恢复之间存在正相关，而AIS D患者的MAP值与神经功能恢复之间没有正相关。这些数据提出了一种可能性，即初始完全性脊髓损伤患者可能比初始AIS D损伤患者从MAP增强中获得更大的益处。
BACKGROUND: Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mm Hg for 7 days following SCI to minimize spinal cord ischemia. Some physicians doubt that patients with initially complete injuries benefit.OBJECTIVE: To assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score.METHODS: High-frequency MAP values of acute SCI patients admitted over a 6-year period were recorded, and values were correlated with degree of neurologic recovery in an analysis stratified by postresuscitation AIS score.RESULTS: Sixty-two patients with SCI were analyzed. Thirty-three patients were determined to have complete injuries, and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 +/- 0.07 mm Hg vs. 94.4 +/- 0.06 mm Hg, respectively; P < 0.001), and the proportion of MAP values < 85 mm Hg was significantly lower (13.5% vs. 25.6%, respectively; P < 0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients but was not observed in patients who were initially AIS D.CONCLUSION: A positive correlation was observed between MAP values and neurologic recovery in AIS A, B, and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries.