Cerebral Hemodynamic Effects of Cheyne-Stokes Respiration in a Patient with Stroke
Cerebral Hemodynamic Effects of Cheyne-Stokes Respiration in a Patient with Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2017.02.026
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发表时间：
2017-05-01
影响因子：
2.5
通讯作者：
Bor-Seng-Shu, E.
中科院分区：
文献类型：
--
作者：
Nogueira, R. C.;Panerai, R. B.;Bor-Seng-Shu, E.
简介：潮式呼吸 (CSR) 和中枢性睡眠呼吸暂停 (CSA) 在心力衰竭和/或中风患者中很常见。我们的目的是描述 CSR 在心力衰竭患者中风急性期对脑血管的影响。病例报告：一名74岁男性，既往患有扩张型心肌病，突发右侧偏瘫、失语。进行经颅多普勒连续测量血压（BP）（Finometer）和呼气末二氧化碳（鼻二氧化碳图）。血流动力学数据的离线分析揭示了与 CSR 呼吸模式相关的脑血流速度和血压的相对较大的周期性波动。计算了脑血管阻力的衍生变量（临界闭合压和阻力面积乘积），表明该亚组患者的受影响半球可能存在肌源性脑血流（CBF）控制障碍。结论：缺血性卒中和 CSR 患者受影响半球的 CBF 调节存在障碍，凸显了脑血流动力学监测在这种情况下的作用。
Introduction: Cheyne-Stokes respiration (CSR) and central sleep apnea (CSA) are common in patients with heart failure and/or stroke. We aim to describe the cerebrovascular effects of CSR during the acute phase of stroke in a heart failure patient. Case Report: A 74-year-old male with previous dilated cardiomyopathy had sudden onset of right hemiparesis and aphasia. A transcranial Doppler was performed with continuous measurement of blood pressure (BP) (Finometer) and end-tidal CO2 (nasal capnography). Offline analysis of hemodynamic data disclosed relatively large periodic oscillations of both cerebral blood flow velocity and BP related to the CSR breathing pattern. Derivate variables from the cerebrovascular resistance were calculated (critical closing pressure and resistance-area product), demonstrating that there may be a myogenic impairment of cerebral blood flow (CBF) control in the affected hemisphere of this subgroup of patient. Conclusion: There is an impairment of CBF regulation in the affected hemisphere of the patient with ischemic stroke and CSR, highlighting the role of cerebral hemodynamic monitoring in this scenario.