Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment
Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment
复制标题
DOI：
10.1007/s12028-015-0125-x
复制
发表时间：
2015-10-01
影响因子：
3.5
通讯作者：
Larrue, Vincent
中科院分区：
文献类型：
--
作者：
Calviere, Lionel;Nasr, Nathalie;Larrue, Vincent
蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）的风险与大脑动脉血管痉挛相关，但血管痉挛不是DCI的强预测因子。经颅多普勒（TCD）检测脑血管自动调节功能可提高对DCI的预测价值。这项前瞻性研究的目的是评估TCD衍生变量单独或联合用于预测DCI的价值。我们纳入了动脉瘤破裂4天内的低级别蛛网膜下腔出血的连续患者。利用脑血流速度和动脉血压自发波动计算的移动相关系数Mx评价脑自动调节。30例患者（19例女性和11例男性;平均年龄+/- A SD 44.7 +/- A 12.1岁）被纳入研究。20例（66.7%）患者发生血管痉挛。6例（20%）患者在中位延迟10天（范围8-13天）后发生DCI。脑自动调节在基线和第7天受损，然后在第14天恢复正常。脑自动调节功能障碍和大动脉痉挛均与DCI无关。相比之下，从基线到第7天，大动脉血管痉挛与脑自动调节受损恶化的组合与随后的DCI显著相关（p = 0.007）。在轻度SAH后大动脉血管痉挛患者中，脑自动调节早期恶化强烈预测DCI。我们的研究结果表明，考虑脑血流速度和脑自动调节可能会提高DCI的预测。
The risk of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is associated with large cerebral artery vasospasm, but vasospasm is not a strong predictor for DCI. Assessment of cerebral autoregulation with transcranial Doppler (TCD) may improve the prediction of DCI. The aim of this prospective study was to assess the value of TCD-derived variables to be used alone or in combination for prediction of DCI.We included consecutive patients with low-grade aneurysmal SAH within 4 days of aneurysm rupture. Cerebral autoregulation was evaluated using the moving correlation coefficient Mx calculated from spontaneous fluctuations of cerebral blood flow velocities and arterial blood pressure. Transcranial color-coded sonography was performed to assess large artery vasospasm.Thirty patients (19 women and 11 men; mean age +/- A SD 44.7 +/- A 12.1 years) were included. Twenty (66.7 %) patients had vasospasm. DCI occurred in six (20 %) patients after a median delay of 10 days (range 8-13 days). Cerebral autoregulation was impaired at baseline and at day 7 and then returned to normal at day 14. Neither cerebral autoregulation impairment nor large artery vasospasm alone was associated with DCI. In contrast, the combination of large artery vasospasm with worsening impairment of cerebral autoregulation from baseline to day 7 was significantly correlated to subsequent DCI (p = 0.007).Early deterioration of cerebral autoregulation was strongly predictive of DCI in patients with large artery vasospasm after low-grade SAH. Our results suggest that consideration to both cerebral blood flow velocities and cerebral autoregulation may improve the prediction of DCI.