| Objective1.To explore the characteristics of impaired dynamic cerebral autoregulation in patients with altered consciousness with neurocritical illnesses.2.Exploring the correlation between the dynamic cerebral autoregulation and TCM syndromes in patients with altered consciousness.MethodsIn this study,32 cases of altered consciousness patients and 13 cases of normal conscious patients admitted to the Neurocritical Care Department of The Second Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2020 to October 2020 were included consecutively.We collect the patient’s demographic data,past medical history,GCS and NIHSS score at admission and four-diagnosis data of traditional Chinese medicine.Serial measurement were performed on 24h,2-4 days,5 days,7days,and 14 days after the onset.Bilateral middle cerebral artery blood flow velocity and simultaneous ABP were recorded with Transcranial Doppler ultrasound combined with invasive radial artery blood pressure monitoring.Transfer function analysis was used to calculate dCA parameters,including phase,gain and consistency in extremely low frequency、low frequency and high frequency.To explore the characteristics of impaired cerebral blood flow autoregulation in patients with altered consciousness and its correlation with TCM syndromes.Results1.Comparing patients with altered consciousness and normal consciousness,the low frequency phase of patients with altered consciousness was significantly lower than that of patients with normal consciousness(25.06±8.80 VS 32.94± 11.69,P=0.018)within 24 hours of onset;on the 5th day of onset,the low frequency increase of altered consciousness patients was significantly lower than that of normal consciousness(0.98±0.30 VS 1.33±0.25,P=0.019);There was no significant difference in parameters related to dynamic celebral autoregulation on day 2-4,day 7 and day 14 of onset between the two groups.2.Comparing the bilateral cerebral hemispheres of patients with altered consciousness,the low frequency phase of the contralateral side of altered consciousness patients was always higher than that of the ipsilateral side Within 7 days of onset,and the low frequency phase contrast between the two sides at the onset of 24h,day 2-4 and day 7 was statistically significant(P=0.017,P=0.007474,P=0.003453);on the 14th day of onset,there was no significant difference in the low frequency phase of the bilateral side;Within 24 hours of onset,the bilateral low frequency gain of the good prognosis group was significantly higher than that of the poor prognosis group(contralateral side:1.21 ±0.65 VS 0.68±0.26,P=0.004;ipsilateral side:1.00±0.47 VS 0.68±0.245,P=0.017).3.In patients with acute severe ischemic stroke,On days 2-4 and 7 of patients with acute severe ischemic stroke,the low frequency phase of the contralateral side was significantly higher than that of the ipsilateral side(27.39±4.97 VS 21.60±3.66,P=0.006;27.15±6.86 VS 21.52±4.51,P=0.016)On days 2-4 and 7;In patients with acute severe intracerebral hemorrhage,the high frequency gain of the contralateral side was significantly higher than that of the ipsilateral side(1.21±0.36 VS 0.95±0.34,P=0.027)Within 24 hours;on the 2-4 days of onset,the extremely low frequency phase of the contralateral side was significantly lower than the ipsilateral side(33.03± 11.58 VS 40.60± 13.17,P=0.016);on the 14th day of onset,the low frequency gain of the contralateral side was significantly lower than the ipsilateral side(1.18±0.15 VS 1.35±0.15,P=0.007).4.The mRS score at 3 months after discharge was positively correlated with the low frequency gain of the contralateral side within 24 hours of onset(r=0.354,P=0.047),and positively correlated with the high frequency phase of the contralateral side(r=0.420,P=0.017).5.On day 2-4 of onset,the cerebral blood flow velocity of patients with Yang-qi occlusion syndrome was significantly lower than that of patients with Yin-qi occlusion syndrome(56.5±29.5cm/S VS 81.3±14.5cm/S,P=0.044).On day 5 of onset,the very low frequency gain of the contralateral side of patients with Yin-qi occlusio syndrome was significantly lower than that of patients with Yang-qi occlusion syndrome(0.82±0.26 VS 1.37±0.59,P=0.016).Conclusion1.Comparing patients with altered consciousness and normal consciousness,the cerebral autoregulation function of the contralateral side in the altered consciousness group was more severely impaired than the normal consciousness group Within 24 hours of onset;On the 5th day of oneset,the cerebral autoregulation function of the ipsilateral side in the normal consciousness group was more severely impaired than the normal consciousness group.2.Comparing the bilateral cerebral hemispheres of patients with altered consciousness,the cerebral autoregulation function of the contralateral side in the altered consciousness group retained better than the ipsilateral side Within 7 days of onset;and the cerebral autoregulation function of the ipsilateral side gradually recovered to the level of the contralateral side on the 14th day of the onset.3.In patients with acute severe ischemic stroke,the cerebral autoregulation function in the ipsilateral side was continuously impaired Within 7 days of the onset,and it gradually recovered to the level of 24 hours after the onset on the 14th day;In patients with acute severe intracerebral hemorrhage,the cerebral autoregulation function in both side was continuously impaired.4.When using transfer function analysis to study the correlation between dynamic cerebral autoregulation function and prognosis,gain degree has limited value in predicting prognosis.5.In patients with altered consciousness,cerebral blood flow velocity was related to TCM syndromes,while the dynamic celebral autoregulation was not significantly related to Yin-qi occlusion syndromes and Yang-qi syndrome occlusion syndromes. |
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