Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke
Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke
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DOI：
10.1111/j.1600-0404.2011.01515.x
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发表时间：
2012-03-01
影响因子：
3.5
通讯作者：
Hetzel, A.
中科院分区：
文献类型：
--
作者：
Reinhard, M.;Rutsch, S.;Hetzel, A.
目的-脑自动调节在急性缺血性卒中中尤其受到挑战。我们研究了（1）急性脑卒中中与动态脑自动调节（DCA）相关的临床和放射学因素以及（2）DCA与脑卒中临床结局的关系。方法-共45例大脑中动脉（MCA）卒中患者进行了分析，合并两个先前的研究。通过经颅多普勒测量早期（发病后48小时内）和晚期（第5-7天）MCA的DCA，使用低频相位和相关分析（指数Mx）。平均治疗4个月后采用改良兰金量表评估疗效。结果- Mx增加（i. e.早期和晚期测量之间的自动调节恶化），受累侧（P = 0.005）比未受累侧（P = 0.014）更严重。较低的同侧相位（早期和晚期）和较高的Mx（晚期测量）所示的钾离子自动调节与较大的梗死显著相关。更严重的卒中与同侧Mx和相位差显著相关。根据单因素分析，早期同侧相位（P = 0.019）和晚期测量的Mx（P = 0.016）与不良临床结局相关。结论：急性缺血性卒中同侧DCA受损与较大梗死相关.在中风后的第一天，自动调节障碍倾向于恶化并扩散到对侧，并且与不良的临床结果相关。
Objectives - Cerebral autoregulation is particularly challenged in acute ischemic stroke. We investigated (1) clinical and radiological factors related to dynamic cerebral autoregulation (DCA) in acute stroke and (2) the relationship between DCA and clinical outcome of stroke. Methods - A total of 45 patients with middle cerebral artery (MCA) stroke were analyzed pooling two previous studies. DCA was measured by transcranial Doppler in both MCAs early (within 48 h from onset) and late (day 5-7) using low-frequency phase and correlation analysis (index Mx). Outcome was assessed by modified Rankin scale after a mean period of 4 months. Results - Mx increased (i. e. autoregulation worsened) between the early and late measurement, more so on affected (P = 0.005) than on unaffected sides (P = 0.014). Poorer autoregulation as indicated by lower ipsilateral phase (early and late) and higher Mx (late measurement) were significantly related to larger infarction. More severe stroke was significantly related to poorer ipsilateral Mx and phase. Ipsilateral phase in the early (P = 0.019) and Mx in the late measurement (P = 0.016) were related to poor clinical outcome according to univariate analysis. Conclusions - Impairment of DCA ipsilateral to acute ischemic stroke is associated with larger infarction. Dysautoregulation tends to worsen and spread to the contralateral side over the first days post- stroke and is associated with poor clinical outcome.