Relationship between endothelial function and vascular stiffness on lower limit of cerebral autoregulation in patients undergoing cardiovascular surgery
Relationship between endothelial function and vascular stiffness on lower limit of cerebral autoregulation in patients undergoing cardiovascular surgery
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心血管手术患者脑自动调节下限内皮功能与血管僵硬度的关系
DOI：
10.1111/aor.13868
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发表时间：
2021
影响因子：
2.4
通讯作者：
Atsushi Yamaguchi
中科院分区：
文献类型：
--
作者：
Daijiro Hori;Yohei Nomura;Mitsunori Nakano;Kei Akiyoshi;Naoyuki Kimura;Atsushi Yamaguchi
基于脑自动调节范围的血流动力学管理是心血管手术中保持主要器官灌注的可能策略。本研究的目的是评价血管特性与大脑自动调节（LLA）下限的关系。采用近红外光谱法监测66例心血管手术患者的LLA。为了确定LLA监测的临床重要性，我们评估了低于LLA的血压偏离与急性肾损伤（AKI）的关系。通过测量血流介导的舒张（FMD）和脉搏波速度（PWV）来评估内皮功能和主动脉硬度。评估与LLA相关的变量。排除血液透析患者，有15名患者（25.9%）发生AKI。发生AKI的患者低于LLA的血压偏差更高（4.55 mm Hg × hr vs. 1.23 mm Hg × hr，P= 0.017）。在单因素分析中，缺血性心脏病患病率（非IHD: 53±13.0 mm Hg vs IHD: 60.0±13.6 mm Hg，P= 0.056）和FMD （r= - 0.42, 95% CI - 0.61 ~ - 0.19，P< 0.001）与体外循环（CPB）前LLA相关。CPB期间，钙通道阻滞剂（无Ca阻滞剂：42±10.6 mm Hg vs. Ca阻滞剂：49±14.3 mm Hg，P= 0.033）、糖尿病（无DM: 44±13.2 mm Hg vs. DM: 55±10.0 mm Hg，P= 0.024）、FMD （r= - 0.32, 95% CI - 0.55 ~ - 0.05，P= 0.021）和PWV （r= 0.28, 95% CI 0.012 ~ 0.513，P= 0.041）与LLA相关。多因素分析显示，CPB前FMD与LLA相关（r= - 2.19, 95% CI为- 3.621 ~ - 0.755，P= 0.003）， CPB期间PWV与LLA相关（r= 0.01, 95% CI为0.001 ~ 0.019，P= 0.023）。内皮功能和主动脉硬度可能是决定心血管手术不同阶段LLA的重要因素。
Hemodynamic management based on cerebral autoregulation range is a possible strategy for preserving major organ perfusion during cardiovascular surgery. The purpose of this study was to evaluate the relation of vascular properties with lower limit of cerebral autoregulation (LLA). LLA was monitored in 66 patients undergoing cardiovascular surgery using near‐infrared spectroscopy. To determine the clinical importance of LLA monitoring, association of blood pressure excursions below LLA and acute kidney injury (AKI) was evaluated. Flow‐mediated dilation (FMD) and pulse wave velocity (PWV) were measured for the evaluation of endothelial function and aortic stiffness. Variables associated with LLA were evaluated. Excluding patients on hemodialysis, there were 15 patients (25.9%) who developed AKI. Blood pressure excursions below LLA were higher in patients who developed AKI (4.55 mm Hg × hr vs. 1.23 mm Hg × hr,P= .017). In the univariate analysis, prevalence of ischemic heart disease (No IHD: 53 ± 13.0 mm Hg vs. IHD: 60.0 ± 13.6 mm Hg,P= .056) and FMD (r= −0.42, 95% CI −0.61 to −0.19,P< .001) were associated with LLA before cardiopulmonary bypass (CPB). During CPB, calcium channel blocker (No Ca blocker: 42 ± 10.6 mm Hg vs. Ca blocker: 49 ± 14.3 mm Hg,P= .033), diabetes (no DM: 44 ± 13.2 mm Hg vs. DM: 55 ± 10.0 mm Hg,P= .024), FMD (r= −0.32, 95% CI −0.55 to −0.05,P= .021), and PWV (r= 0.28, 95% CI 0.012 to 0.513,P= .041) were associated with LLA. Multivariate analysis showed that FMD was correlated with LLA before CPB (r= −2.19, 95% CI −3.621 to −0.755,P= .003), while PWV was correlated with LLA during CPB (r= 0.01, 95% CI 0.001‐0.019,P= .023). Endothelial function and aortic stiffness may be important factors in determining LLA at different phases in cardiovascular surgery.