年龄或心血管合并症是预测老年脑外伤患者脑血管压力反应性降低的主要因素吗?

IF 1.9 Q3 CLINICAL NEUROLOGY
Floor Vanelderen, Dominike Bruyninckx, Bart Depreitere
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引用次数: 0

摘要

导言压力反应指数(PRx)被认为是衡量脑血管自动调节能力(CA)的替代指标,有研究表明年龄越大,压力反应指数越低。材料和方法这是对 2013 年至 2023 年间连续收集的 151 名创伤性脑损伤(TBI)患者的前瞻性数据进行的回顾性分析。PRx 是 5 个监测日的平均值,并与人口统计学、患者和损伤数据相关联。以 PRx 为因变量,心血管合并症、年龄、格拉斯哥运动评分和瞳孔反应为自变量,进行了多元回归分析。结果 在单变量分析中,年龄、性别、血栓栓塞史、动脉高血压、格拉斯哥运动评分和瞳孔反应与 PRx 显著相关。在多变量分析中,年龄对 PRx 有明显的恶化影响(p = 0.01),而心血管风险因素和损伤严重程度则没有影响。讨论与结论在对创伤性脑损伤患者进行的这项队列研究中发现,无论是否患有心血管并发症,年龄越大,脑血管压力反应性越差。创伤性脑损伤的病理生理学和老化生理学似乎共同对脑灌注产生了负面影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is age or cardiovascular comorbidity the main predictor of reduced cerebrovascular pressure reactivity in older patients with traumatic brain injury?

Introduction

The Pressure Reactivity index (PRx) has been proposed as a surrogate measure for cerebrovascular autoregulation (CA) and it has been described that older age is associated with worse PRx. The etiology for this reduced capacity remains unknown.

Research question

To investigate the relation between age and PRx in a cohort of patients with traumatic brain injury (TBI) while correcting for cardiovascular comorbidities.

Material and methods

This is a retrospective analysis on prospectively collected data in 151 consecutive TBI patients between 2013 and 2023. PRx was averaged over 5 monitoring days and correlated with demographic, patient and injury data. A multiple regression analysis was performed with PRx as dependent variable and cardiovascular comorbidities, age, Glasgow motor score and pupillary reaction as independent variables. A similar model was constructed without age and compared.

Results

Age, sex, thromboembolic history, arterial hypertension, Glasgow motor score and pupillary reaction significantly correlated with PRx in univariate analysis. In multivariate analysis, age had a significant worsening effect on PRx (p = 0.01), while the cardiovascular risk factors and injury severity had no impact. The comparison of the models with and without age yielded a significant difference (p = 0.01), underpinning the independent effect of age.

Discussion and conclusion

In the present cohort study in TBI patients it was found that older age independently impaired cerebrovascular pressure reactivity regardless of cardiovascular comorbidity. Pathophysiology of TBI and physiology of ageing seem to line up to synergistically produce a negative effect on brain perfusion.

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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
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审稿时长
71 days
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