Effects of prolonged mild hypothermia on cerebral blood flow after cardiac arrest
Effects of prolonged mild hypothermia on cerebral blood flow after cardiac arrest
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DOI：
10.1097/ccm.0b013e318255d983
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发表时间：
2012-08-01
影响因子：
8.8
通讯作者：
Hoedemaekers, Cornelia W. E.
中科院分区：
文献类型：
--
作者：
Bisschops, Laurens L. A.;van der Hoeven, Johannes G.;Hoedemaekers, Cornelia W. E.
目的：观察无脉搏电活动/停搏或顽固性室颤患者经亚低温治疗72小时后脑血流量和脑氧摄取的变化。设计：观察性研究。地点：三级护理大学医院。患者：10例昏迷患者无脉搏电活动/停搏或长时间室颤后恢复自主循环。干预：亚低温治疗72小时。测量和主要结果：入院后12、24、36、48、60、72、84、96和108小时经颅多普勒测量大脑中动脉平均血流速度。在相同的时间间隔测量颈静脉球氧分压。入院时大脑中动脉平均血流速度较低(26.5(18.7~48.0)cm/s)，72小时后显著增加至63.9(45.6~65.6)cm/s(p=0.002)。复温后，大脑中动脉的平均血流速度保持相对恒定，108小时大脑中动脉的平均血流速度为71.5(56.0-78.5)(p=.381)。颈静脉球血氧饱和度在研究开始时为57.0(51.0-61.3)%，在72小时后逐渐增加到81.0(78.5-88.0)%(p=0.003)。复温后，颈静脉球血氧保持恒定，108小时时颈静脉球血氧饱和度为84.0(77.3-86.3)%(p=.919)。存活者和死亡者大脑中动脉平均血流速度、搏动指数和颈静脉球血氧分压无差异。结论：温度本身可能不是心脏骤停后脑血流调节的主要决定因素。大脑中动脉平均血流速度相对较低，颈静脉球血氧饱和度正常，提示大脑代谢活动减少，这可能是(延长)亚低温在延迟性低灌注期发挥神经保护作用的原因之一。(Crit Care Med 2012；40：2362-2367)
Objective: The aim of the present study was to assess the cerebral blood flow and cerebral oxygen extraction in adult patients after pulseless electrical activity/asystole or resistant ventricular fibrillation who were treated with mild therapeutic hypothermia for 72 hrs.Design: Observational study.Setting: Tertiary care university hospital.Patients: Ten comatose patients with return of spontaneous circulation after pulseless electrical activity/asystole or prolonged ventricular fibrillation.Intervention: Treatment with mild therapeutic hypothermia for 72 hrs.Measurements and Main Results: Mean flow velocity in the middle cerebral artery was measured by transcranial Doppler at 12, 24, 36, 48, 60, 72, 84, 96, and 108 hrs after admission. Jugular bulb oxygenation was measured at the same intervals. Mean flow velocity in the middle cerebral artery was low (26.5 (18.7-48.0) cm/sec) at admission and significantly increased to 63.9 (45.6-65.6) cm/sec at 72 hrs (p = .002). Upon rewarming, the mean flow velocity in the middle cerebral artery remained relatively constant with a mean flow velocity in the middle cerebral artery of 71.5 (56.0-78.5) at 108 hrs (p = .381). Jugular bulb oxygenation at the start of the study was 57.0 (51.0-61.3)% and gradually increased to 81.0 (78.5-88.0)% at 72 hrs (p = .003). Upon rewarming, the jugular bulb oxygenation remained constant with a jugular bulb oxygenation of 84.0 (77.3-86.3)% at 108 hrs (p = .919). There were no differences in mean flow velocity in the middle cerebral artery, pulsatility index, and jugular bulb oxygenation between survivors and nonsurvivors.Conclusions: Temperature by itself is probably not a major determinant in regulation of cerebral blood flow after cardiac arrest. The relatively low mean flow velocity in the middle cerebral artery in combination with normal jugular bulb oxygenation values suggests a reduction in cerebral metabolic activity that may contribute to the neuroprotective effect of (prolonged) mild therapeutic hypothermia in the delayed hypoperfusion phase. (Crit Care Med 2012; 40: 2362-2367)