脑梗死急性期患者脑血流自动调节功能观察

doi:10.3969/j.issn.1673-5765.2018.08.014

摘要/Abstract

摘要：

目的利用临界关闭压（critical closing pressure，CCP）探讨脑梗死急性期自动调节功能及与病情的相关性。

方法收集起病3 d内的脑梗死急性期患者，于入院当天使用经颅多普勒超声、连续无创血压监测仪同步记录大脑前动脉、大脑中动脉、大脑后动脉血流和桡动脉血压，计算CCP，并于入院当天进行美国国立卫生研究院卒中量表（National Institutes of Health stroke scale，NIHSS）评分、改良Rankin量表（modified Rankin scale，mRS）评分，起病3个月进行mRS评分，探讨脑梗死急性期脑血流自动调节功能及其与病情的相关性。

结果脑梗死急性期患者CCP与对照组比较无明显差异。但对于脑梗死患者，大脑中动脉组大脑中动脉的CCP与入院时NIHSS评分，以及大脑后动脉组大脑后动脉的CCP与入院时NIHSS和mRS评分呈明显正相关（r =0.536、0.600、0.518，P＜0.05）。CCP与起病3个月mRS分值相关性不明显。

结论脑梗死责任血管的CCP可反映疾病严重程度。

文章导读： 脑血流自动调节与脑梗死急性期病情相关，明确脑血流自动调节功能有助于脑梗死诊治。

关键词: 脑血流自动调节; 经颅多普勒超声; 临界关闭压; 脑梗死

Abstract:

Objective To explore the changes of autoregulation of cerebral blood flow in acute cerebral infarction and its relationship with clinical stroke severity based on critical closing pressure (CCP) theory. Methods All patients who had acute cerebral infarction within 3 days were detected by TCD and continuous non-invasive blood pressure monitor on admission, recording the curves of blood flow velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) and radial artery blood pressure, to work out the values of CCP of responsible arteries. National Institutes of Health stroke scale (NIHSS) scores, modified Rankin scale (mRS) scores on admission and mRS scores at 3 months were recorded. The changes of autoregulation of cerebral blood flow in acute cerebral infarction group and its relationship with clinical stroke severity were evaluated. Results There was no difference in the value of CCP between cerebral infarction group and health control group. For regional responsible vessels in cerebral infarction group, the CCP of MCA was correlative with NIHSS score on admission, and the CCP of PCA were correlative with NIHSS score and mRS score on admission (r =0.536, 0.600, 0.518, P <0.05), but not associated with mRS score at 3 months. Conclusions The CCP values of responsible arteries in patients with acute cerebral infarction can reflect the severity of stroke.

Key words: Autoregulation of cerebral blood flow; Transcranial Doppler; Critical closing pressure; Cerebral infarction

许冰冰, 高庆春, 黎明坤, 李学龙, 林婉蓉, 张伟劲, 杨继党. 脑梗死急性期患者脑血流自动调节功能观察[J]. 中国卒中杂志, 2018, 13(08): 829-833.

XU Bing-Bing, GAO Qing-Chun, LI Ming-Kun, LI Xue-Long, LIN Wan-Rong, ZHANG Wei-Jin, YANG Ji-Dang. Autoregulation of Cerebral Blood Flow in Acute Cerebral Infarction and Its Relationship with Clinical Stroke Severity[J]. Chinese Journal of Stroke, 2018, 13(08): 829-833.

参考文献

[1] PANERAI R B. Nonstationarity of dynamic cerebral

autoregulation[J]. Med Eng Phys2014365

576-584.

[2] TIECKS F PLAM A MAASLID Ret al.

Comparison of static and dynamic cerebral

autoregulation measurements[J]. Stroke199526

61014-1019.

[3] SCHONDORF RBENOIT JWEIN T.

Cerebrovascular and cardiovascular measurements

during neurally mediated syncope induced by headup

tilt[J]. Stroke19972881564-1568.

[4] THEES CSCHOLZ MSCHALLER M D Cet al.

Relationship between intracranial pressure and critical

closing pressure in patients with neurotrauma[J].

Anesthesiology2002963595-599.

[5] EDOUARD A RVANHILLE ELE MOIGNO S

et al. Non-invasive assessment of cerebral perfusion

pressure in brain injured patients with moderate

intracranial hypertension[J]. Br J Anaesth200594

2216-221.

[6] VARSOS G VBUDOHOSKI K PCZOSNYKA

Met al. Cerebral vasospasm affects arterial critical

closing pressure[J]. J Cereb Blood Flow Metab2015

352285-291.

[7] JAGERSBERG MSCHALLER CBOSTROM

Jet al. Simultaneous bedside assessment of global

cerebral blood flow and effective cerebral perfusion

pressure in patients with intracranial hypertension[J].

Neurocrit Care2010122225-233.

[8] GARNHAM JPANERAI R BNAYLOR A Ret

al. Cerebrovascular response to dynamic changes in

pCO2[J]. Cerebrovasc Dis199993146-151.

[9] CASTRO P MSANTOS RFREITAS Jet

al. Autonomic dysfunction affects dynamic

cerebral autoregulation during Valsalva maneuver

comparison between healthy and autonomic

dysfunction subjects[J]. J Appl Physiol19852014

1173205-213.

[10] TIECKS F PLAM A MMATTA B Fet al. Effects

of the valsalva maneuver on cerebral circulation

in healthy adults. A transcranial Doppler study[J].

Stroke19952681386-1392.

[11] 蔼.琄...╭宾单. ノ......

.﹚胺眃.﹀瑈...[J]. い..眃蝋

200592573-75.

[12] 蔼.琄┑柳..单. 蔼﹀.公.﹀恨

.甡.....刹[J]. い.ρみ.﹀恨痜

.в200574272-275.

[13] ..﹀恨痚痜..璶.[J]. い...в

1996296379-380.

[14] WILTERDINK J LBENDIXEN BADAMS H

P JRet al. Effect of prior aspirin use on stroke

severity in the trial of Org 10172 in acute stroke

treatmentTOAST[J]. Stroke20013212

2836-2840.

[15] Χ▆..蔼.琄单. .碻.....

Τ.拈猔....﹚よ猭╯[J]. い.禬.紇

钩..в2005145366-369.

[16] AASLID RLASH S RBARDY G Het al.

Dynamic pressure--flow velocity relationships in the

human cerebral circulation[J]. Stroke2003347

1645-1649.

[17] SAEED N PPANERAI R BHORSFIELD M Aet

al. Does stroke subtype and measurement technique

influence estimation of cerebral autoregulation in

acute ischaemic stroke?[J]. Cerebrovasc Dis2013

353257-261.

[18] REINHARD MRUTSCH SLAMBECK Jet al.

Dynamic cerebral autoregulation associates with

infarct size and outcome after ischemic stroke[J].

Acta Neurol Scand20121253156-162.

[19] PETERSEN N HORTEGA-GUTIERREZ S

RECCIUS Aet al. Dynamic cerebral autoregulation

is transiently impaired for one week after largevessel

acute ischemic stroke[J]. Cerebrovasc Dis

2015392144-150.