Altered Cerebral Vasoregulation Predicts the Outcome of Patients with Partial Anterior Circulation Stroke
Altered Cerebral Vasoregulation Predicts the Outcome of Patients with Partial Anterior Circulation Stroke
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DOI：
10.1159/000334851
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发表时间：
2012-01-01
影响因子：
2.4
通讯作者：
Caltagirone, Carlo
中科院分区：
文献类型：
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作者：
Troisi, Elio;Matteis, Maria;Caltagirone, Carlo
背景与目的：本研究旨在探讨脑卒中后脑血流动力学变化与神经功能缺损演变的相关性。方法：我们纳入事件发生后4周内入院的65例非腔隙性卒中患者。采用屏气指数（BHI）经颅多普勒超声评价脑血管对高碳酸血症的反应性。以Barthel指数（BI）衡量日常生活活动状况，以Rivermead活动能力指数（RMI）评估活动能力受损。采用治疗效果进行多变量分析，以BI和RMI作为因变量进行评估。自变量为BHI值、年龄、性别、住院时间、高血压、吸烟习惯、失语和忽视、卒中后抑郁和卒中严重程度。结果：BI的有效性与正常BHI值和入院时的神经系统严重程度呈正相关，由加拿大神经学量表测量。RMI有效性的回归系数显示，最相关的预测因子是同侧BHI（斜率结果等于5.8），其次是年龄（10岁的年龄差异预计会使有效性降低约4.3%）和抑郁（抑郁症患者的有效性比非抑郁症患者低近11%）。结论：这些发现表明，尽管存在解剖病变，但神经功能缺损的满意恢复需要在病变半球保留脑血管反应性。巴塞尔S. Karger股份有限公司版权所有
Background and Purpose: The aim of this study was to investigate the correlation between cerebral hemodynamic changes and the evolution of neurological deficit after stroke. Methods: We included 65 patients with non-lacunar stroke admitted to a rehabilitation hospital within 4 weeks from the event. An evaluation of cerebrovascular reactivity to hypercapnia was performed with transcranial Doppler ultrasonography using the breath-holding index (BHI). Activities of daily living status was measured by the Barthel Index (BI) and impairment of mobility was assessed by means of the Rivermead Mobility Index (RMI). Multivariate analyses were performed using effectiveness of treatment, evaluated on BI and RMI as dependent variables. Independent variables were BHI values, age, sex, length of stay, hypertension, smoking habit, presence of aphasia and neglect, poststroke depression, and the degree of severity of stroke. Results: The effectiveness on BI was associated positively with normal BHI values and with neurological severity at admission, measured by the Canadian Neurological Scale. The regression coefficients for effectiveness on RMI showed that the most relevant predictor was ipsilateral BHI (the slope resulted equal to 5.8), followed by age (a 10-year age difference is expected to diminish the effectiveness by about 4.3%) and by depression (depressed patients have almost 11% less effectiveness than non-depressed patients). Conclusion: These findings suggest that a satisfactory recovery from neurologic deficits requires a preserved cerebrovascular reactivity in the lesioned hemisphere despite the presence of an anatomic lesion. Copyright (C) 2012 S. Karger AG, Basel