Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction
Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction
复制标题
DOI：
10.1161/01.str.0000251642.18522.b6
复制
发表时间：
2007-01-01
期刊：
影响因子：
8.3
通讯作者：
Heiss, Wolf-Dieter
中科院分区：
文献类型：
--
作者：
Dohmen, Christian;Bosche, Bert;Heiss, Wolf-Dieter
背景和目的：为了研究脑血管自动调节及其对即将发生恶性大脑中动脉梗死患者临床病程的影响，我们采用了侵入性多模式神经监测，包括脑灌注压、组织氧分压和微透析的测量。将探针置于同侧额叶。通过计算脑灌注压-氧反应性指数（COR）和脑灌注压与组织氧分压的相关系数（R）来评估脑卒中后24小时和72小时的自动调节。（即大量水肿形成）与7例良性病程患者相比，（COR，1.99 +/- 1.46对0.68 +/- 0.29; R，0.49 +/- 0.28对0.06 +/- 0.31; P < 0.05），表明恶性病程组的自动调节受损。在72小时时，与良性病程组相比，在恶性病程组中观察到COR和R进一步增加，随着时间的推移，COR和R值稳定（COR，3.31 +/- 2.38对0.75 +/- 0.31; R，0.75 +/- 011对0.36 +/- 0.27; P < 0.05）。当COR为0.99时，发现预测恶性病程的临界值，在两个时间点，恶性病程患者的乳酸-丙酮酸比值均高于良性病程患者。COR，R，乳酸-丙酮酸比显示出显着的相关性与结果参数作为中线移位颅计算机断层扫描和评分的修改后的兰金规模after 3 months. Conclusions，我们发现早期损害脑血管自动调节在周围梗死组织的恶性脑水肿的患者，而自动调节被保存在患者的良性过程。受损的脑自动调节似乎在恶性过程的发展中起着关键作用，并可能作为一个预测标志物。受损的脑自动调节也强调了需要随之调整脑灌注压受损的自动调节患者。
Background and Purpose-To study cerebrovascular autoregulation and its impact on clinical course in patients with impending malignant middle cerebral artery infarction, we used invasive multimodal neuromonitoring, including measurement of cerebral perfusion pressure, tissue oxygen pressure, and microdialysis.Methods-Fifteen patients with a stroke that involved > 50% of the middle cerebral artery territory were included. Probes were placed into the ipsilateral frontal lobe. Autoregulation was assessed by calculation of the cerebral perfusion pressure-oxygen reactivity index (COR) and the correlation coefficient (R) of cerebral perfusion pressure and tissue oxygen pressure at 24 and 72 hours after stroke.Results-COR and R at 24 hours after stroke were higher in the 8 patients with a malignant course (ie, massive edema formation) compared with the 7 patients with a benign course (COR, 1.99 +/- 1.46 versus 0.68 +/- 0.29; R, 0.49 +/- 0.28 versus 0.06 +/- 0.31; P < 0.05), indicating impaired autoregulation in the malignant course group. At 72 hours, further increases in COR and R were observed in the malignant course group in contrast to the benign course group with stable values over time (COR, 3.31 +/- 2.38 versus 0.75 +/- 0.31; R, 0.75 +/- 011 versus 0.36 +/- 0.27; P < 0.05). With a COR of 0.99, a cutoff value for prediction of a malignant course was found. The lactate-pyruvate ratio was higher in patients with a malignant compared with a benign course at both time points. COR, R, and the lactate-pyruvate ratio showed significant correlations with outcome parameters as a midline shift on cranial computed tomography and score on the modified Rankin scale after 3 months.Conclusions-We found early impairment of cerebrovascular autoregulation in peri-infarct tissue of patients who developed malignant brain edema, whereas autoregulation was preserved in patients with a benign course. Impaired cerebral autoregulation seems to play a key role for development of a malignant course and might serve as a predictive marker. Impaired cerebral autoregulation also accentuates the need for consequent adjustment of cerebral perfusion pressure in patients with impaired autoregulation.