■这项研究调查了平均动脉血压(MAP)与血管加压药的要求,心脏骤停(CA)后缺氧缺血性脑病(HIE)的严重程度。
■在2008年至2017年之间,我们回顾性分析了CA后200小时的MAP,并使用累积血管加压素指数(CVI)量化了血管加压素的要求。通过对非幸存者的尸检,HIE的严重程度在组织病理学上分为无/轻度和重度HIE。在幸存者中,我们将HIE的严重程度分为无/轻度脑表现类别(CPC)1和重度HIE(CPC4)。我们调查了意识的恢复,死亡原因,和5天生存率作为血液动力学混杂因素。
■在350名非幸存者中,117有组织病理学上严重的HIE,而233没有/轻度HIE,在MAP中没有观察到差异(73.1vs.72.0mmHg,pgroup=0.639)。与非幸存者相比,211例CPC1和57例CPC4患者的MAP值较高,显示显着,但与临床无关,MAP差异(81.2与82.3mmHg,pgroup<0.001)。无/轻度HIE非幸存者(n=54),死前恢复意识的人,与无/轻度HIE(n=179)相比,MAP值更高,谁持续昏迷(74.7vs.69.3mmHg,pgroup<0.001)。无/轻度HIE非幸存者,恢复意识的人,需要更少的血管加压药(CVI2.1vs.3.6,pgroup<0.001)。独立于HIE的严重程度,幸存者更快脱离血管加压药(CVI1.0).
■尽管在血管加压药支持的MAP目标高于65mmHg的CA患者中,较高的MAP与生存率相关,HIE的严重性不是。从昏迷中醒来与血管加压药需求减少有关。我们的结果没有证据表明MAP目标高于当前指南建议,可以降低HIE的严重程度。
UNASSIGNED: This study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA).
UNASSIGNED: Between 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders.
UNASSIGNED: Among the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg, pgroup = 0.639). Compared to the non-survivors, 211 patients with CPC 1 and 57 patients with CPC 4 had higher MAP values that showed significant, but clinically non-relevant, MAP differences (81.2 vs. 82.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors (n = 54), who regained consciousness before death, had higher MAP values compared to those with no/mild HIE (n = 179), who remained persistently comatose (74.7 vs. 69.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors, who regained consciousness, required fewer vasopressors (CVI 2.1 vs. 3.6, pgroup < 0.001). Independent of the severity of HIE, the survivors were weaned faster from vasopressors (CVI 1.0).
UNASSIGNED: Although a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.