30°头位改善再灌注治疗患者的动态大脑自我调节：一项前瞻性自我对照研究

IF 3.4 4区医学 Q2 CLINICAL NEUROLOGY

Journal of Neurorestoratology Pub Date : 2025-08-22 DOI:10.1016/j.jnrt.2025.100241

Yi Gao , Ye Sun , Zhuo Liu , Yi Yang , Jia-Xin Ren , Qiu-Xia Deng , Yang Qu , Fan Chen , Peng Zhang , Zi-Duo Shen , Xiu-Li Yan , Zhen-Ni Guo

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引用次数: 0

摘要

目前，脑卒中患者接受再灌注治疗的最佳头部位置尚不清楚。因为不同的头部位置可能对动态大脑自动调节（dCA）产生不同的影响。方法采用经颅多普勒联合伺服控制手指体积描记仪，连续记录再灌注后24 h、3 d、7 d头颅0°和30°位置时大脑中动脉脑血流速度（CBFV）和手指血压。然后使用这些数据通过传递函数分析计算dCA参数（相位差[PD]，增益和相干函数）。同时，还包括30名健康对照者。结果83例接受再灌注治疗的患者纳入最终分析。对于双方来说，30°头位在24小时（患病侧：p = 0.047，未患病侧：p = 0.003）、3天（患病侧：p = 0.040，未患病侧：p = 0.016）、7天（患病侧：p <； 0.001，未患病侧：p <； 0.001）时的相位差均显著高于0°头位。患侧和未患侧头部0°和30°位置脑血流速度无显著差异。此外，在健康对照组中，不同头部位置的dCA和脑血流速度没有差异。结论急性缺血性脑卒中再灌注治疗患者头部30°体位有利于改善dCA。

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The 30° head position improves dynamic cerebral autoregulation in patients undergoing reperfusion therapy: A prospective self-controlled study

Background

At present, the optimal head position for stroke patients undergoing reperfusion therapy remains unclear. Because different head positions may exert distinct effects on dynamic cerebral autoregulation (dCA).

Methods

In this self-controlled study, the cerebral blood flow velocity (CBFV) in the middle cerebral artery and finger blood pressure at the 0° and 30° head positions were continuously recorded using transcranial Doppler combined with servo-controlled finger plethysmography at 24 h, 3 days, and 7 days after reperfusion. These data were then used to calculate the dCA parameters (phase difference [PD], gain, and coherence function) through transfer function analysis. Meanwhile, 30 healthy controls were included.

Results

Finally, 83 patients who underwent reperfusion therapy were included in the final analysis. For both sides, the phase difference in the 30° head position was significantly higher at 24 h (affected side: p = 0.047; unaffected side: p = 0.003), 3 days (affected side: p = 0.040, unaffected side: p = 0.016)), and 7 days (affected side: p < 0.001; unaffected side: p < 0.001) than that in the 0° head position. There was no significant difference in cerebral blood flow velocity between the 0° and 30° head positions on both affected and unaffected sides. Additionally, no difference of dCA and cerebral blood flow velocity was found in different head positions among healthy controls.