■存在对直立活动(坐着,站立,和行走)急性缺血性中风后的早期可能是在此关键阶段脑灌注的减少。我们的目的是估计48小时内及以后直立姿势(坐着和站着)对脑血流动力学的影响,中风后3-7天,在有和没有闭塞性疾病的中风患者和对照组中。
■我们在0°头部位置使用经颅多普勒研究了MCAv,然后在30°,70°,90°坐姿,站立90°,在中风后<48小时,后来在中风后3-7天。使用混合效应线性回归模型来估计0°和其他位置之间的MCAv差异,并比较各组之间的MCAv变化。
■总共42名中风参与者(前循环和后循环)(13名患有闭塞性疾病,29个没有)和22个对照被招募。在患有闭塞性疾病的中风(中风后<48小时)中,受影响的半球MCAv降低:从0°坐姿到90°坐姿(-9.9cm/s,95%CI[-16.4,-3.4])和0°至90°站立(-7.1cm/s,95CI[-14.3,-0.01])。在没有闭塞性疾病的中风中,受影响的半球MCAv也降低:从0°坐姿到90°坐姿(-3.3cm/s,95CI[-5.6,-1.1])和从0°到90°站立(-3.6cm/s,95CI[-5.9,-1.3])(p值相互作用卒中与无闭塞性疾病=0.07)。在对照组中也观察到直立时MCAv的降低:从0°到90°坐姿(-3.8cm/s,95CI[-6.0,-1.63])和从0°到90°站立(-3cm/s,95CI[-5.2,-0.81])(p值交互作用卒中与controls=0.85)。前循环卒中的亚组分析显示,受累半球MCAv的变化模式相似,患有闭塞性疾病的患者(n=11)和没有闭塞性疾病的患者(n=26)之间存在显着的相互作用(p=0.02)。卒中后<48小时MCAv从0°到直立的变化与3-7天相似。在<48小时时MCAv的变化与30天改良的Rankin量表之间没有发现关联。
■中风后<2天移动到更直立的位置确实会降低受影响半球的MCAv;但是,这些变化对于有或没有闭塞性疾病的卒中参与者(前循环和后循环)没有显着差异,也不是为了控制。患有闭塞性疾病的前循环中风中MCAv的降低与没有闭塞性疾病的显着不同。然而,样本量很小,并且需要更多的研究来证实这些发现。
UNASSIGNED: Concerns exist that a potential mechanism for harm from upright activity (
sitting, standing, and walking) early after an acute ischaemic stroke could be the reduction of cerebral perfusion during this critical phase. We aimed to estimate the effects of upright positions (
sitting and standing) on cerebral hemodynamics within 48 h and later, 3-7 days post-stroke, in patients with strokes with and without occlusive disease and in controls.
UNASSIGNED: We investigated MCAv using transcranial Doppler in 0° head position, then at 30°, 70°, 90°
sitting, and 90° standing, at <48 h post-stroke, and later at 3-7 days post-stroke. Mixed-effect linear regression modeling was used to estimate differences in MCAv between the 0° and other positions and to compare MCAv changes across groups.
UNASSIGNED: A total of 42 stroke participants (anterior and posterior circulation) (13 with occlusive disease, 29 without) and 22 controls were recruited. Affected hemisphere MCAv decreased in strokes with occlusive disease (<48 h post-stroke): from 0° to 90° sitting (-9.9 cm/s, 95% CI[-16.4, -3.4]) and from 0° to 90° standing (-7.1 cm/s, 95%CI[-14.3, -0.01]). Affected hemisphere MCAv also decreased in strokes without occlusive disease: from 0° to 90°
sitting (-3.3 cm/s, 95%CI[-5.6, -1.1]) and from 0° to 90° standing (-3.6 cm/s, 95%CI [-5.9, -1.3]) (p-value interaction stroke with vs. without occlusive disease = 0.07). A decrease in MCAv when upright was also observed in controls: from 0° to 90°
sitting (-3.8 cm/s, 95%CI[-6.0, -1.63]) and from 0° to 90° standing (-3 cm/s, 95%CI[-5.2, -0.81]) (p-value interaction stroke vs. controls = 0.85). Subgroup analysis of anterior circulation stroke showed similar patterns of change in MCAv in the affected hemisphere, with a significant interaction between those with occlusive disease (n = 11) and those without (n = 26) (p = 0.02). Changes in MCAv from 0° to upright at <48 h post-stroke were similar to 3-7 days. No association between changes in MCAv at <48 h and the 30-day modified Rankin Scale was found.
UNASSIGNED: Moving to more upright positions <2 days post-stroke does reduce MCAv in the affected hemisphere; however, these changes were not significantly different for stroke participants (anterior and posterior circulation) with and without occlusive disease, nor for controls. The decrease in MCAv in anterior circulation stroke with occlusive disease significantly differed from without occlusive disease. However, the sample size was small, and more research is warranted to confirm these findings.