Intraoperative Blood Pressure and Carbon Dioxide Values during Aneurysmal Repair and the Outcomes after Aneurysmal Subarachnoid Hemorrhage.
Intraoperative Blood Pressure and Carbon Dioxide Values during Aneurysmal Repair and the Outcomes after Aneurysmal Subarachnoid Hemorrhage.
复制标题
DOI：
10.3390/jcm12175488
复制
发表时间：
2023-08-24
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
--
作者：
脑自动调节功能障碍是蛛网膜下腔出血（SAH）引起的继发性脑损伤的一个重要方面，也被证明是迟发性脑缺血（DCI）和神经功能不良结局的独立预测因子。有趣的是，术中血流动力学和血流动力学参数被证明会影响SAH后患者的结局。本研究的目的是评价术中低血压和低碳酸血症与血管造影性血管痉挛、DCI和出院时神经功能结局的相关性。收集了2010年1月至2018年5月期间接受全身麻醉进行动脉瘤夹闭术或弹簧圈栓塞术的390例蛛网膜下腔出血患者的术中数据。我们测量了术中平均血压和呼气末二氧化碳（ETCO 2），以及低血压负荷的曲线下面积（AUC）：SBP低于100或MBP低于65和低碳酸血症（ETCO 2 < 30）。结局指标为血管造影性血管痉挛、DCI和出院时的神经系统结局（通过改良兰金量表评分测量）（mRS 0-2为良好结局，3-6为不良结局）。进行单变量和logistic回归分析，以评估血压（BP）和ETCO 2变量是否与结局指标独立相关。在390例患者中，132例（34%）发生了中度至重度血管痉挛，114例（29%）发生了DCI，46%（169）的患者出院时神经功能结局良好。测量的术中BP和ETCO 2变量均与血管造影性血管痉挛、DCI或不良神经功能结局无关。我们的研究没有发现SAH患者术中低血压或低碳酸血症的程度与血管造影性血管痉挛、DCI或出院时神经功能结局之间存在独立相关性。
Cerebral autoregulation impairment is a critical aspect of subarachnoid hemorrhage (SAH)-induced secondary brain injury and is also shown to be an independent predictor of delayed cerebral ischemia (DCI) and poor neurologic outcomes. Interestingly, intraoperative hemodynamic and ventilatory parameters were shown to influence patient outcomes after SAH. The aim of the current study was to evaluate the association of intraoperative hypotension and hypocapnia with the occurrence of angiographic vasospasm, DCI, and neurologic outcomes at discharge. Intraoperative data were collected for 390 patients with aneurysmal SAH who underwent general anesthesia for aneurysm clipping or coiling between January 2010 and May 2018. We measured the mean intraoperative blood pressure and end-tidal carbon dioxide (ETCO2), as well as the area under the curve (AUC) for the burden of hypotension: SBP below 100 or MBP below 65 and hypocapnia (ETCO2 < 30), during the intraoperative period. The outcome measures were angiographic vasospasm, DCI, and the neurologic outcomes at discharge as measured by the modified Rankin scale score (an mRS of 0–2 is a good outcome, and 3–6 is a poor outcome). Univariate and logistic regression analyses were performed to evaluate whether blood pressure (BP) and ETCO2 variables were independently associated with outcome measures. Out of 390 patients, 132 (34%) developed moderate-to-severe vasospasm, 114 (29%) developed DCI, and 46% (169) had good neurologic outcomes at discharge. None of the measured intraoperative BP and ETCO2 variables were associated with angiographic vasospasm, DCI, or poor neurologic outcomes. Our study did not identify an independent association between the degree of intraoperative hypotension or hypocapnia in relation to angiographic vasospasm, DCI, or the neurologic outcomes at discharge in SAH patients.
登录
查看更多内容
影响因子：
2.9
作者：
Steiner, Thorsten;Juvela, Seppo;Rinkel, Gabriel
通讯作者：
Rinkel, Gabriel
影响因子：
1.6
作者：
Chong, Jong-Yun;Kim, Dong-Won;Kim, Kwang-Myung
通讯作者：
Kim, Kwang-Myung
影响因子：
3.5
作者：
Williamson, Craig A.;Sheehan, Kyle M.;Rajajee, Venkatakrishna
通讯作者：
Rajajee, Venkatakrishna
影响因子：
4.1
作者：
Ayling, Oliver G. S.;Ibrahim, George M.;Macdonald, R. Loch
通讯作者：
Macdonald, R. Loch
影响因子：
8.3
作者：
Sudlow, CLM;Warlow, CP
通讯作者：
Warlow, CP