自发性脑出血患者的连续动脉血压指数与早期血肿扩大

IF 1.3 Q4 CLINICAL NEUROLOGY Brain Hemorrhages Pub Date : 2024-10-01 DOI:10.1016/j.hest.2024.06.001
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引用次数: 0

摘要

目的血压变异性(BPV)及其与脑内出血(ICH)早期血肿扩大(HE)的潜在联系仍有待全面阐明。我们的研究探讨了入院后 24 小时内的血压变异与 ICH 中血肿扩大之间的潜在联系。方法在一项前瞻性队列单中心研究中,我们分析了连续的自发性 ICH 患者。我们分析了入院后 0-2、0-8、0-12 和 0-24 小时内通过动脉管路提取的连续血压数据。通过所有可用血压测量值的连续变异性 (SV)、标准差 (SD) 和变异系数 (CV) 评估血压变异性。早期 HE 的定义是 24 小时随访脑成像中 ICH 体积绝对值[≥ 6 ml]或相对值[≥ 33 %]增加。次要终点是入院时血压的影响以及 HE 的其他潜在风险因素。结果在 305 名 ICH 患者(平均年龄(± SD)70.1±14.9 岁,47.9% 为女性,中位 NIHSS 6(3,13)分,中位 ICH 评分 1(1,2)分)中,41 人(13.4%)出现 HE。HE 患者入院时的 NIHSS(p = 0.015)、ICH 评分(p = 0.005)、ICH 容量(p < 0.001)和抗凝前治疗(p = 0.004)均较高。有高血压的 ICH 患者与没有高血压的患者相比,BPV 没有差异。但 HE 患者入院时的舒张压(76.6 ± 14.8 vs. 86.3 ± 19.7 mmHg,p = 0.005)和血压(103.2 ± 22.4 vs. 112.2 ± 22.6,p = 0.027)明显较低。逻辑回归显示,较大的 ICH 容量和预先存在的抗凝是 HE 的重要预测因素,而较高的初始舒张压可降低 HE 风险。与 ICH < 30 cm3 相比,出血量≥ 30 cm3 的患者在所有时间段内的初始舒张压、MAP 和 BPV 都明显较低。入院时舒张压较低、使用抗凝药和较大的 ICH 容量是 HE 的潜在预测因素。然而,出血量较大(30 立方厘米)的患者绝对血压和血压变异指数较低,临床预后较差。这些研究结果表明,血压动态变化与 ICH 严重程度之间存在微妙的关系,强调了在急性 ICH 护理中进行个体化血压管理的必要性。有必要开展进一步的研究来探索这些关系并优化治疗策略。
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Continuous arterial blood pressure indices and early hematoma expansion in patients with spontaneous intracerebral hemorrhage

Objective

Blood pressure variability (BPV) and its potential association with early hematoma expansion (HE) in intracerebral hemorrhage (ICH) remains to be fully elucidated. Our study explores the potential link between BPV within the first 24 h after admission and HE in ICH.

Methods

In a prospective cohort single-center study, we analyzed consecutive patients with spontaneous ICH. Continuous BP data via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) were analyzed over 0–2, 0–8, 0–12, and 0–24 h intervals post-admission. BPV was assessed through successive variability (SV), standard deviation (SD), and coefficient of variation (CV) using all available BP measurements. Early HE was defined as an absolute [≥ 6 ml] or relative [≥ 33 %] increase in ICH volume on 24-hours follow-up brain imaging. Secondary endpoints were the influence of BP on admission and other potential risk factors for HE.

Results

Among 305 ICH-patients (mean age ± SD 70.1 ± 14.9 years, 47.9 % female, median NIHSS 6 (3, 13), median ICH score 1 (1, 2)), 41 (13.4 %) experienced HE. HE-patients had higher NIHSS (p = 0.015), ICH-score (p = 0.005), ICH volume (p < 0.001) and higher pre-anticoagulation treatment (p = 0.004) on admission. There was no difference in BPV comparing ICH-patients with HE to those without. However, patients with HE had significantly lower diastolic BP (76.6 ± 14.8 vs. 86.3 ± 19.7 mmHg, p = 0.005) and MAP (103.2 ± 22.4 vs. 112.2 ± 22.6, p = 0.027) on admission. This pattern of lower diastolic BP persisted across the first 24 h. Logistic regression revealed larger ICH volume and pre-existing anticoagulation as significant predictors of HE, with higher initial diastolic BP reducing HE risk. Hemorrhages ≥ 30 cm3 showed significantly lower initial diastolic BP, MAP, and BPV across all time frames compared to ICH < 30 cm3.

Conclusions

BPV within the first 24 h was not associated with HE. Lower diastolic BP on admission, anticoagulation use, and larger ICH volume are potential predictors for HE. However, larger hemorrhage size (>30 cm3) experienced lower absolute BP and BPV indices and worse clinical outcomes. These findings suggest a nuanced relationship between BP dynamics and ICH severity, underscoring the need for individualized BP management in acute ICH care. Further research is necessary to explore these relationships and optimize treatment strategies.
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来源期刊
Brain Hemorrhages
Brain Hemorrhages Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
52
审稿时长
22 days
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