Vasopressor Infusion After Subarachnoid Hemorrhage Does Not Increase Regional Cerebral Tissue Oxygenation.
Vasopressor Infusion After Subarachnoid Hemorrhage Does Not Increase Regional Cerebral Tissue Oxygenation.
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DOI：
10.1097/jnn.0000000000000382
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发表时间：
2018-08
期刊：
影响因子：
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通讯作者：
Hravnak M
中科院分区：
文献类型：
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作者：
Yousef KM;Crago E;Chang Y;Lagattuta TF;Mahmoud K;Shutter L;Balzer JR;Pinsky MR;Friedlander RM;Hravnak M
血管加压药常用于蛛网膜下腔出血（aSAH）后维持脑压梯度。然而，血管加压药和脑微循环支持程度之间的关系仍不清楚。本研究旨在探讨aSAH患者局部脑组织和外周组织氧饱和度（rSO 2）以及血压（BP）在血管加压药治疗前后的变化。在aSAH后14天内，使用近红外光谱法获得连续非侵入性脑和外周rSO 2。在控制Hunt和Hess分级和血管痉挛的情况下，分析了血管加压剂输注开始前后rSO 2的受试者内差异。在45例持续rSO 2监测的患者中，19例（42%）接受了血管加压素输注（所有19例均接受去甲肾上腺素，2例加肾上腺素，4例苯肾上腺素，2例加压素）。在这19例患者中，血管加压药输注时间与较高的血压（收缩压[B=15.1]、舒张压[B=7.3]和平均值[B=10.1]，p=001）相关，但与较低的大脑rSO 2相关（左脑rSO 2降低4.4% [B=-4.4，p<.0001];右脑rSO 2降低5.5% [B=-5.5，p=.0002]）。尽管在血管加压药输注期间全身血压升高，但同时脑rSO 2降低。这些结果值得进一步研究诱导高血压对脑微循环的影响。
Vasopressors are commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to sustain cerebral pressure gradients. Yet, the relationship between vasopressors and the degree of cerebral microcirculatory support achieved remains unclear. This study aimed to explore the changes in regional cerebral and peripheral tissue oxygen saturation (rSO2) as well as blood pressure (BP) before and after vasopressor infusion in aSAH patients. Continuous non-invasive cerebral and peripheral rSO2 was obtained using near-infrared spectroscopy for up to 14 days after aSAH. Within-subjects differences in rSO2 before and after the commencement of vasopressor infusion were analyzed controlling for Hunt and Hess grade and vasospasm. Of 45 patients with continuous rSO2 monitoring, 19 (42%) received vasopressor infusion (all 19 on norepinephrine, plus epinephrine in 2, phenylephrine in 4, and vasopressin in 2). In these 19, their vasopressor infusion times were associated with higher BP (systolic [b=15.1], diastolic [b=7.3] and mean [b=10.1], p=001), but lower cerebral rSO2 (left cerebral rSO2 decreased by 4.4% [b=-4.4, p<.0001]; right cerebral rSO2 decreased by 5.5% [b=-5.5, p=.0002]). Despite elevation in systemic BP during vasopressor infusion times, cerebral rSO2 was concurrently diminished. These findings warrant further investigation for the effect of induced hypertension on cerebral microcirculation.