急性前循环脑梗死患者脑血流自动调节 与预后的相关性分析

Association between Dynamic Cerebral Autoregulation and Short-term Outcome in Patients with Anterior Circulation Stroke

摘要:

〔摘 要〕 目的：探讨急性前循环脑梗死患者急性期动态脑血流自动调节（dCA）与 90 d 预后的相关性。方法：选择 2019 年 3 月至 2019 年 9 月期间于深圳市第二人民医院神经内科住院部住院的急性前循环脑梗死患者 17 例（观察组）和健 康志愿者 17 例（对照组）为研究对象。于观察组急性期和脑梗死 90 d 时使用经颅多普勒超声（TCD）联合指尖无创连续血 压分别监测双侧大脑中动脉（MCA）血流速度（CBFV）和指尖血压，并计算相位（phase）和增益（gain），脑梗死 90 d 时以改良 Rankin 量表（mRS）评分评估日常生活能力，复查脑血流自动调节（CA）功能，并与对照组相关结果进行比较。 结果：急性前循环脑梗死患者病灶侧和对侧 phase 值均显著低于对照组，差异具有统计学意义（P ＜ 0.01）；脑梗死 90 d 后双侧 phase 值和对照组的差异无统计学意义（P ＞ 0.05）；观察组病灶侧 phase 值和 90 d mRS 评分呈负相关（r = –0.55， P = 0.02）。结论：急性前循环脑梗死患者双侧大脑半球 dCA 能力均受损，90 d 后可恢复至正常水平，急性期 dCA 水平可 以一定程度上预测短期功能预后。

Abstract:

〔Abstract〕 Objective This study aimed to explore the relationship between dynamic cerebral autoregulation and shortterm outcome in patients with anterior circulation strokes. Methods 17 patients with anterior circulation strokes and 17 healthy controls from March 2019 to September 2019 in the neurology department of the First Affiliated Hospital of Shenzhen University were collected. Noninvasive continuous cerebral blood flow velocity of the bilateral middle artery and arterial blood pressure were recorded within 7 days of onset. Transfer function analysis (TFA) was applied to calculate dCA parameters (phase and gain). The clinical prognosis was assessed using the mRS at 90 days. Dynamic cerebral autoregulation was reviewed at 90 days and compared with the control group. Results The focal and contralateral phases were significantly lower in patients with acute anterior circulation stroke with controls (P < 0.05). There was no significant difference between strokes with controls after 90 days. In the stroke group, phase of the lesion side was negatively correlated with the 90 d mRS score (r = -0.55, P = 0.02). Conclusion dCA of both hemispheres is impaired in the acute phase in anterior circulation stroke, and it will fully recover after 90 days, and it can predict the short-term functional prognosis.