Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage
Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage
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DOI：
10.1212/wnl.57.1.18
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发表时间：
2001-07-10
期刊：
影响因子：
9.9
通讯作者：
Diringer, MN
中科院分区：
文献类型：
--
作者：
Powers, WJ;Zazulia, AR;Diringer, MN
背景：动脉高血压在急性脑出血（ICH）后24小时内很常见，虽然升高的血压通常在几天内降至基线值，但在急性期的适当治疗仍然存在争议，反对治疗急性ICR患者高血压的争论主要基于降低动脉血压会减少脑血流量（CBF）的担忧。作者进行了这项研究，以提供关于急性脑出血患者平均动脉压（MAP）药理学降低时全脑和周围区域CBF变化的进一步信息。方法：在发病6至22小时后研究了14例急性幕上脑出血1至45mt的患者。用PET和150-water测定脑血流。在完成第一次CBF测量后，患者随机接受尼卡地平或拉贝他洛尔治疗，以降低15%的MAP，并重复CBF研究。结果：MAP从143 +/- 10降低到119 +/- 11 mmhg，降低了-16.7 +/- 5.4%。无论是整体CBF还是心包CBF均无显著变化。95% CI的计算表明，总体或周包CBF下降超过-2.7 mL 100 g(-1) min（-1）的可能性小于5%。结论：在小到中度急性脑出血患者中，动脉窝压在研究范围内降低，CBF的自动调节得以保留。
Background: Arterial hypertension is common in the first 24 hours after acute intracerebral hemorrhage (ICH), Although increased blood pressure usually declines to baseline values within several days, the appropriate treatment during the acute period has remained controversial, Arguments against treatment of hypertension in patients with acute ICR are based primarily on the concern that reducing arterial blood pressure will reduce cerebral blood flow (CBF). The authors undertook this study to provide further information on the changes in whole-brain and periclot regional CBF that occur with pharmacologic reductions in mean arterial pressure (MAP) in patients with acute ICH, Methods: Fourteen patients with acute supratentorial ICH 1 to 45 mt in size were studied 6 to 22 hours after onset. CBF was measured with PET and 150-water. After completion of the first CBF measurement, patients were randomized to receive either nicardipine or labetalol to reduce MAP by 15%, and the CBF study was repeated. Results: MAP was lowered by -16.7 +/- 5.4% from 143 +/- 10 to 119 +/- 11 mm Hg. There was no significant change in either global CBF or periclot CBF. Calculation of the 95% CI demonstrated that there is less than a 5% chance that global or periclot CBF fell by more than -2.7 mL 100 g(-1) min(-1). Conclusion: In patients with small- to medium-sized acute ICH, autoregulation of CBF was preserved with arterial brood pressure reductions in the range studied.