Hypertonic Saline In Patients With Poor-Grade Subarachnoid Hemorrhage Improves Cerebral Blood Flow, Brain Tissue Oxygen, and pH
Hypertonic Saline In Patients With Poor-Grade Subarachnoid Hemorrhage Improves Cerebral Blood Flow, Brain Tissue Oxygen, and pH
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DOI：
10.1161/strokeaha.109.560698
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发表时间：
2010-01-01
期刊：
影响因子：
8.3
通讯作者：
Kirkpatrick, Peter J.
中科院分区：
文献类型：
--
作者：
Al-Rawi, Pippa G.;Tseng, Ming-Yuan;Kirkpatrick, Peter J.
背景和目的：脑血流减少导致的迟发性脑缺血和脑梗死仍然是动脉瘤性蛛网膜下腔出血后预后不良的主要原因。高渗盐水（HS）与CBF增加有关。本研究探讨了HS对重度蛛网膜下腔出血患者脑血流增强是否与脑组织氧合改善有关。方法：连续监测44例患者的动脉血压、颅内压、脑灌注压、脑组织氧、二氧化碳、pH、大脑中动脉血流速度。患者输注23.5% HS 2 mL/kg。16例患者同时行氙气CT扫描。计算组织氧传感器周围区域的脑血流。数据为平均值+/- SD。结果：注射后30min，大鼠动脉血压、脑灌注压、血流速度、脑组织pH、脑组织氧含量显著升高，颅内压显著降低（P < 0.05）。颅内压降低持续300分钟，血流速度升高持续240分钟。脑组织氧的显著增加持续了240分钟。平均基线区域CBF为33.9 +/- 13.5 mL/100 g/min， HS后上升20.3% +/- 37.4% （P < 0.05）。与预后不良的患者相比，预后良好的患者在CBF增加、脑组织氧、pH和颅内压降低方面对HS的反应更好。脑组织氧持续增加（超过210分钟）与良好的结果相关（P < 0.023）。结论：hs可增强重度蛛网膜下腔出血患者的脑血流，并可显著改善输注后4小时脑氧合。210分钟后脑组织氧的改善与良好的结果相关。(中风。2010;41:122 - 128)。
Background and Purpose-Delayed cerebral ischemia and infarction due to reduced CBF remains the leading cause of poor outcome after aneurysmal subarachnoid hemorrhage. Hypertonic saline (HS) is associated with an increase in CBF. This study explores whether CBF enhancement with HS in patients with poor-grade subarachnoid hemorrhage is associated with improved cerebral tissue oxygenation.Methods-Continuous monitoring of arterial blood pressure, intracranial pressure, cerebral perfusion pressure, brain tissue oxygen, carbon dioxide, pH, and middle cerebral artery flow velocity was performed in 44 patients. Patients were given an infusion (2 mL/kg) of 23.5% HS. In 16 patients, xenon CT scanning was also performed. CBF in a region surrounding the tissue oxygen sensor was calculated. Data are mean +/- SD.Results-Thirty minutes postinfusion, a significant increase in arterial blood pressure, cerebral perfusion pressure, flow velocity, brain tissue pH, and brain tissue oxygen was seen together with a decrease in intracranial pressure (P < 0.05). Intracranial pressure remained reduced for > 300 minutes and flow velocity elevated for > 240 minutes. A significant increase in brain tissue oxygen persisted for 240 minutes. Average baseline regional CBF was 33.9 +/- 13.5 mL/100 g/min, rising by 20.3% +/- 37.4% (P < 0.05) after HS. Patients with favorable outcome responded better to HS in terms of increased CBF, brain tissue oxygen, and pH and reduced intracranial pressure compared with those with an unfavorable outcome. A sustained increase in brain tissue oxygen (beyond 210 minutes) was associated with favorable outcome (P < 0.023).Conclusion-HS augments CBF in patients with poor-grade subarachnoid hemorrhage and significantly improves cerebral oxygenation for 4 hours postinfusion. Favorable outcome is associated with an improvement in brain tissue oxygen beyond 210 minutes. (Stroke. 2010;41:122-128.)