Cerebral Vascular Changes During Acute Intracranial Pressure Drop
Cerebral Vascular Changes During Acute Intracranial Pressure Drop
复制标题
DOI：
10.1007/s12028-018-0651-4
复制
发表时间：
2019-06-01
影响因子：
3.5
通讯作者：
Hu, Xiao
中科院分区：
文献类型：
--
作者：
Liu, Xiuyun;Zimmermann, Lara L.;Hu, Xiao
目的应用一种新型脑室外导管，同时监测颅内压和脑脊液引流，研究急性脑脊液引流时的脑血管反应。方法回顾分析6例34例次脑室外引流。根据脑脊液引流过程中颅内压波形的变化，采用模板匹配算法计算脑血管扩张指数(VDI)和脑血管收缩指数(VCI)的概率。计算EVD开放后ICPB波的功率变化(P)。结果急性脑脊液引流可显着降低平均颅内压(P=0.016)、增加脑室传导速度(P=0.02)、降低颅内压B波功率(P=0.016)。当颅内压在10~25 mm Hg范围内时，VCI对颅内压的变化呈负性反应，当颅内压在10~25 mm Hg范围外时，VCI无明显变化。VCI与ICPB波功率呈负相关(r=-0.44)，VDI与ICPB波功率呈正相关(r=0.82)，提示血管收缩功能越强，ICPB波功率下降越大。脑脊液急性引流可降低平均颅内压，并导致血管收缩，可通过血管收缩指数来检测。脑血管在一定范围内对颅内压或脑灌注压的变化有积极的反应，超过一定范围后，血管对颅内压和脑灌注压的变化不敏感。
ObjectiveThis study applied a new external ventricular catheter, which allows intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) drainage simultaneously, to study cerebral vascular responses during acute CSF drainage.MethodsSix patients with 34 external ventricular drain (EVD) opening sessions were retrospectively analyzed. A published algorithm was used to extract morphological features of ICP recordings, and a template-matching algorithm was applied to calculate the likelihood of cerebral vasodilation index (VDI) and cerebral vasoconstriction index (VCI) based on the changes of ICP waveforms during CSF drainage. Power change (P) of ICP B-waves after EVD opening was also calculated. Cerebral autoregulation (CA) was assessed through phase difference between arterial blood pressure (ABP) and ICP using a previously published wavelet-based algorithm.ResultsThe result showed that acute CSF drainage reduced mean ICP (P=0.016) increased VCI (P=0.02) and reduced ICP B-wave power (P=0.016) significantly. VCI reacted to ICP changes negatively when ICP was between 10 and 25mmHg, and VCI remained unchanged when ICP was outside the 10-25mmHg range. VCI negatively (r=-0.44) and VDI positively (r=0.82) correlated with P of ICP B-waves, indicating that stronger vasoconstriction resulted in bigger power drop in ICP B-waves. Better CA prior to EVD opening triggered bigger drop in the power of ICP B-waves (r=-0.612).ConclusionsThis study demonstrates that acute CSF drainage reduces mean ICP, and results in vasoconstriction which can be detected through an index, VCI. Cerebral vessels actively respond to ICP changes or cerebral perfusion pressure (CPP) changes in a certain range; beyond which, the vessels are insensitive to the changes in ICP and CPP.