目的:更好地了解位置对颅内压(ICP)和依从性的影响对于开发可以恢复正常脑脊液(CSF)动力学的治疗策略很重要。关于位置对颅内顺应性的影响的知识有限。在这项横断面研究中,作者测试了脉冲幅度(PA)与位置和昼夜周期的关联。此外,他们描述了具有“正常”ICP动力学的患者的体位ICP和PA变化。
方法:这项单中心回顾性研究包括在2017年10月至2019年9月期间接受选择性24小时ICP监测的疑似和/或确认CSF动力学异常的患者。患者参加了一个短运动电池,包括四个位置:仰卧,腰椎穿刺体位在左侧侧卧位,坐着,和站立。每个姿势保持2分钟,计算每个位置的平均ICP和PA。还收集了24小时白天和晚上的中位数ICP和PA数据。线性回归模型用于检验PA与位置和昼夜周期的相关性。所有线性回归均针对混杂因素进行校正。总结无明显ICP动力学异常患者的体位ICP监测结果。
结果:本研究纳入了平均年龄为39±13岁(平均值±标准差)的一百一十一名患者(24名男性和77名女性)。调整后的线性回归模型显示了ICP与位置和昼夜周期的显着关联,直立(坐着和站着),白天ICP值低于仰卧和夜间ICP值。调整后的线性回归模型对于PA与位置和昼夜周期的关联也很重要,直立和日间PA值高于仰卧和夜间PA结果。对于有和没有分流的患者,这些关联得到了证实。与其他患者相比,无明显ICP动力学异常的患者对其体位ICP变化的控制更为严格;然而,组间差异无统计学意义。
结论:这是调查体位变化对颅内顺应性影响的最大研究。这项研究的结果表明,PA,以及ICP,与姿势显著相关,与仰卧相比,直立姿势增加。需要进一步的研究来调查这种关联背后的机制。
OBJECTIVE: A better understanding of the effect of position on intracranial pressure (ICP) and compliance is important for the development of treatment strategies that can restore normal cerebrospinal fluid (CSF) dynamics. There is limited knowledge on the effect of position on intracranial compliance. In this cross-sectional
study the authors tested the association of pulse amplitude (PA) with position and the day/night cycle. Additionally, they describe the postural ICP and PA changes of patients with \"normal\" ICP dynamics.
METHODS: This single-center retrospective
study included patients with suspected and/or confirmed CSF dynamics abnormalities who had been examined with elective 24-hour ICP monitoring between October 2017 and September 2019. Patients had been enrolled in a short exercise battery including four positions: supine, lumbar puncture position in the left lateral decubitus position, sitting, and standing. Each position was maintained for 2 minutes, and mean ICP and PA were calculated for each position. The 24-hour day and night median ICP and PA data were also collected. Linear regression models were used to test the correlation of PA with position and day/night cycle. All linear regressions were corrected for confounders. The postural ICP monitoring results of patients without obvious ICP dynamics abnormality were summarized.
RESULTS: One hundred one patients (24 males and 77 females) with a mean age of 39 ± 13years (mean ± standard deviation) were included in the
study. The adjusted linear regression models demonstrated a significant association of ICP with position and day/night cycle, with upright (sitting and standing) and day ICP values lower than supine and night ICP values. The adjusted linear regression model was also significant for the association of PA with position and day/night cycle, with upright and day PA values higher than supine and night PA results. These associations were confirmed for patients with and without shunts. Patients without clear ICP dynamics abnormality had tighter control of their postural ICP changes than the other patients; however, the difference among groups was not statistically significant.
CONCLUSIONS: This is the largest
study investigating the effect of postural changes on intracranial compliance. The results of this
study suggest that PA, as well as ICP, is significantly associated with posture, increasing in upright positions compared to that while supine. Further studies will be needed to investigate the mechanism behind this association.