背景:本研究旨在探讨自主循环(ROSC)恢复后最初24小时血脑屏障(BBB)通透性和颅内压(ICP)的变化及其与心脏骤停损伤严重程度的关系。
方法:这项前瞻性研究分析了在ROSC后的最初24小时内每2小时使用白蛋白商(Qa)和ICP评估的BBB通透性。使用匹兹堡心脏骤停类别(PCAC)评分评估心脏骤停的损伤严重程度。主要结果是ROSC后最初24小时BBB通透性和ICP变化的时间过程及其与损伤严重程度的关系(PCAC评分为1-4)。
结果:Qa和ICP分别测量了274和197次,分别,在32名登记患者中。总的来说,ROSC后BBB渗透率随时间逐渐增加,然后在ROSC后18h与基线相比显着增加。相比之下,ICP显示ROSC后最初24小时无显著变化.PCAC2组的Qa<0.01,表明在所有时间点BBB破坏正常或轻度,而PCAC3和4组在14和22h时BBB通透性显着增加,以及ROSC后12和14小时,分别。
结论:尽管进行了复苏护理,但在ROSC后的最初24小时,BBB通透性随时间逐渐增加。而ICP不随时间变化。当按损伤严重程度分层时,BBB通透性具有个体模式。
BACKGROUND: This study aimed to explore the changes in blood-brain barrier (BBB) permeability and intracranial pressure (ICP) for the first 24 h after the return of spontaneous circulation (ROSC) and their association with injury severity of cardiac arrest.
METHODS: This prospective study analysed the BBB permeability assessed using the albumin quotient (Qa) and ICP every 2 h for the first 24 h after ROSC. The injury severity of cardiac arrest was assessed using Pittsburgh Cardiac Arrest Category (PCAC) scores. The primary outcome was the time course of changes in the BBB permeability and ICP for the first 24 h after ROSC and their association with injury severity (PCAC scores of 1-4).
RESULTS: Qa and ICP were measured 274 and 197 times, respectively, in 32 enrolled patients. Overall, the BBB permeability increased progressively over time after ROSC, and then it increased significantly at 18 h after ROSC compared with the baseline. In contrast, the ICP revealed non-significant changes for the first 24 h after ROSC. The Qa in the PCAC 2 group was < 0.01, indicating normal or mild BBB disruption at all time points, whereas the PCAC 3 and 4 groups showed a significant increase in BBB permeability at 14 and 22 h, and 12 and 14 h after ROSC, respectively.
CONCLUSIONS: BBB permeability increased progressively over time for the first 24 h after ROSC despite post-resuscitation care, whereas ICP did not change over time. BBB permeability has an individual pattern when stratified by injury severity.