Cerebral blood flow velocity changes during upright positioning in bed after acute stroke: an observational study
Cerebral blood flow velocity changes during upright positioning in bed after acute stroke: an observational study
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DOI：
10.1136/bmjopen-2013-002960
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Vroomen, Patrick
中科院分区：
文献类型：
--
作者：
Aries, Marcel J.;Elting, Jan Willem;Vroomen, Patrick
目的：国家指南建议急性中风后尽早卧床活动。直立姿势对中风患者实时脑血流变量的影响知之甚少。设计：观察性研究。参与者：47例急性缺血性中风患者和20例健康对照组。主要和次要观察指标：记录双侧经颅多普勒(主要结果)的体位变化，同时记录近红外光谱、呼气末二氧化碳、无创血压数据和神经状态的变化(次要结果)。方法：卧位、半坐(45度)、坐位(70度)和Trendelenburg(-15度)。结果：患者平均年龄为62+/-15岁，入院时美国国立卫生研究院卒中评分中位数为7分(IQR5-14)。在健康对照组和中风患者患侧大脑半球之间，坐位CBFV的平均比例变化没有显著差异。受累和未受影响的中风半球之间以及预后不利和有利的患者之间没有发现显著差异。直立卧位时，所有患者的神经功能均未见恶化或改善。结论：在中风亚急性期，未发现轻、中度中风患者卧床直立姿势对血流量和(额叶)氧合的显著影响。仰卧或Trendelenburg定位似乎并不能增加实时流量变量。
Objectives: National guidelines recommend mobilisation in bed as early as possible after acute stroke. Little is known about the influence of upright positioning on real-time cerebral flow variables in patients with stroke. We aimed to assess whether cerebral blood flow velocity (CBFV) changes significantly after upright positioning in bed in the acute stroke phase.Design: Observational study.Participants: 47 patients with acute ischaemic stroke measured in the subacute phase after symptom onset and 20 healthy controls.Primary and secondary outcome measures: We recorded postural changes in bilateral transcranial Doppler (primary outcome) and simultaneously recorded nearinfrared spectroscopy, end-tidal CO2, non-invasive blood pressure data and changes in neurological status (secondary outcomes).Methods: Postures included the supine, half sitting (45 degrees), sitting (70 degrees) and Trendelenburg (-15 degrees) positions. Using multilevel analyses, we compared postural changes between hemispheres, outcome groups (using modified Rankin Scale) as well as between patients and healthy controls.Results: The mean patient age was 62 +/- 15 years and median National Institute of Health Stroke Scale score on admission was 7 (IQR 5-14). Mean proportional CBFV changes on sitting were not significantly different between healthy controls and affected hemispheres in patients with stroke. No significant differences were found between affected and unaffected stroke hemispheres and between patients with unfavourable and favourable outcomes. During upright positioning, no neurological worsening or improvement was observed in any of the patients.Conclusions: No indications were found that upright positioning in bed in mild to moderately affected patients with stroke compromises flow and (frontal) oxygenation significantly during the subacute phase of stroke. Supine or Trendelenburg positioning does not seem to augment real-time flow variables.