Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data
Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data
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DOI：
10.1089/neu.2014.3778
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发表时间：
2015-12-15
影响因子：
4.2
通讯作者：
Manley, Geoffrey
中科院分区：
文献类型：
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作者：
Hawryluk, Gregory;Whetstone, William;Manley, Geoffrey
目前的急性脊髓损伤（SCI）患者护理指南建议在急性SCI后7天内将平均动脉压（MAP）维持在85- 90mmhg，然而，很少有证据支持这一建议。我们试图更好地了解MAP值与神经恢复之间的关系。计算机系统自动收集并存储重症监护病房监测脊髓损伤患者6年期间的q1min生理数据。收集了100例急性脊髓损伤患者的数据。其中74例患者在入院时和出院时通过体检确定了美国脊髓损伤协会损伤等级（AIS）。从120毫米汞柱到40毫米汞柱，以1毫米汞柱为增量，研究了平均MAP值以及MAP值低于阈值的比例；在损伤后30天内的不同时间点探讨这些措施与结果之间的关系。在1,688,194分钟的重症监护观察中，共记录了纳入患者的994,875q1min动脉线血压测量。尽管平均MAP值普遍可接受，但大部分测量值低于85毫米汞柱。在脊髓损伤后的前2-3天，较高的平均MAP值与改善的恢复相关，而MAP值低于85mm Hg可接受阈值的比例似乎具有更强的相关性，在损伤后的前5-7天强度下降。本研究提供了强有力的证据支持MAP值与神经恢复之间的相关性。然而，它并没有提供因果关系的证据。低血压持续时间可能比平均MAP更重要。这为脊髓损伤恢复中MAP阈值的概念提供了支持，MAP值最高与神经系统恢复程度最高相关。结果与目前的指南一致，认为急性脊髓损伤后MAP阈值为bb0 - 85mmhg可能是合适的。
Current guidelines for the care of patients with acute spinal cord injuries (SCIs) recommend maintaining mean arterial pressure (MAP) values of 85-90mm Hg for 7 days after an acute SCI however, little evidence supports this recommendation. We sought to better inform the relationship between MAP values and neurological recovery. A computer system automatically collected and stored q1min physiological data from intensive care unit monitors on patients with SCI over a 6-year period. Data for 100 patients with acute SCI were collected. 74 of these patients had American Spinal Injury Association Impairment Scale (AIS) grades determined by physical examination on admission and at time of hospital discharge. Average MAP values as well as the proportion of MAP values below thresholds were explored for values from 120mm Hg to 40mm Hg in 1mm Hg increments; the relationship between these measures and outcome was explored at various time points up to 30 days from the time of injury. A total of 994,875q1min arterial line blood pressure measurements were recorded for the included patients amid 1,688,194min of recorded intensive care observations. A large proportion of measures were below 85mm Hg despite generally acceptable average MAP values. Higher average MAP values correlated with improved recovery in the first 2-3 days after SCI while the proportion of MAP values below the accepted threshold of 85mm Hg seemed a stronger correlate, decreasing in strength over the first 5-7 days after injury. This study provides strong evidence supporting a correlation between MAP values and neurological recovery. It does not, however, provide evidence of a causal relationship. Duration of hypotension may be more important than average MAP. It provides support for the notion of MAP thresholds in SCI recovery, and the highest MAP values correlated with the greatest degree of neurological recovery. The results are concordant with current guidelines in suggesting that MAP thresholds >85mm Hg may be appropriate after acute SCI.