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首页> 外文期刊>Fluids and Barriers of the CNS >Cardiac output in idiopathic normal pressure hydrocephalus: association with arterial blood pressure and intracranial pressure wave amplitudes and outcome of shunt surgery
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Cardiac output in idiopathic normal pressure hydrocephalus: association with arterial blood pressure and intracranial pressure wave amplitudes and outcome of shunt surgery

机译：特发性常压性脑积水的心输出量：与动脉血压和颅内压波幅度以及分流手术结局的关系

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Background In patients with idiopathic normal pressure hydrocephalus (iNPH) responding to shunt surgery, we have consistently found elevated intracranial pressure (ICP) wave amplitudes during diagnostic ICP monitoring prior to surgery. It remains unknown why ICP wave amplitudes are increased in these patients. Since iNPH is accompanied by a high incidence of vascular co-morbidity, a possible explanation is that there is reduced vascular compliance accompanied by elevated arterial blood pressure (ABP) wave amplitudes and even altered cardiac output (CO). To investigate this possibility, the present study was undertaken to continuously monitor CO to determine if it is correlated to ABP and ICP wave amplitudes and the outcome of shunting in iNPH patients. It was specifically addressed whether the increased ICP wave amplitudes seen in iNPH shunt responders were accompanied by elevated CO and/or ABP wave amplitude levels. Methods Prospective iNPH patients (29) were clinically graded using an NPH grading scale. Continuous overnight minimally-invasive monitoring of CO and ABP was done simultaneously with ICP monitoring; the CO, ABP, and ICP parameters were parsed into 6-second time windows. Patients were assessed for shunt surgery on clinical grade, Evan's index, and ICP wave amplitude. Follow-up clinical grading was performed 12 months after surgery. Results ICP wave amplitudes but not CO or ABP wave amplitude, showed good correlation with the response to shunt treatment. The patients with high ICP wave amplitude did not have accompanying high levels of CO or ABP wave amplitude. Correlation analysis between CO and ICP wave amplitudes in individual patients showed different profiles [significantly positive in 10 (35%) and significantly negative in 16 (55%) of 29 recordings]. This depended on whether there was also a correlation between ABP and ICP wave amplitudes and on the average level of ICP wave amplitude. Conclusions These results gave no evidence that the increased levels of ICP wave amplitudes seen in iNPH shunt responders prior to surgery were accompanied by elevated levels of ABP wave amplitudes or elevated CO. In the individual patients the correlation between CO and ICP wave amplitude was partly related to an association between ABP and ICP wave amplitudes which can be indicative of the state of cerebrovascular pressure regulation, and partly related to the ICP wave amplitude which can be indicative of the intracranial compliance.
机译：背景技术在对分流手术有反应的特发性正常压力脑积水（iNPH）的患者中，我们一直发现在术前诊断性ICP监测期间颅内压（ICP）波幅度升高。为何这些患者中的ICP波幅值增加仍是未知的。由于iNPH伴随着血管合并症的高发，因此可能的解释是血管顺应性降低，伴随着动脉血压（ABP）波幅的升高甚至心输出量（CO）的改变。为了调查这种可能性，本研究旨在连续监测CO，以确定其是否与iNPH患者的ABP和ICP波幅以及分流的结果相关。专门解决了在iNPH分流应答器中看到的ICP波振幅增加是否伴随着CO和/或ABP波振幅水平升高的问题。方法采用NPH分级量表对29例iNPH患者进行临床分级。与ICP监测同时进行了对CO和ABP的连续过夜微创监测。将CO，ABP和ICP参数解析为6秒的时间窗口。根据临床等级，Evan指数和ICP波幅对患者进行分流手术评估。术后12个月进行随访临床分级。结果ICP波幅值而不是CO或ABP波幅值与分流治疗的响应具有良好的相关性。 ICP波振幅高的患者没有伴随的高水平的CO或ABP波振幅。个别患者的CO和ICP波振幅之间的相关性分析显示出不同的曲线[29个记录中有10个（35％）显着阳性，而16个（55％）显着阴性]。这取决于ABP和ICP波振幅之间是否也存在相关性以及ICP波振幅的平均水平。结论这些结果没有证据表明术前iNPH分流反应器中ICP波幅值的升高伴随着ABP波幅值或CO升高。在个别患者中，CO和ICP波幅值之间的相关性部分相关与ABP和ICP波幅值之间的关联可以指示脑血管压力调节的状态，并且部分与ICP波幅值有关，其可以指示颅内顺应性。

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