| Background and objective:Cerebral autoregulation(CA), a mechanism that protects the brain tissue from either hyperperfusion or hypoperfusion within a wide range of blood pressure fluctuations, is thus of great concern for patients with intracerebral hemorrhage(ICH). Dynamic cerebral autoregulation(d CA) is probably altered in acute ICH. We aim to investigate the temporal course of d CA and its correlation with clinical factors and outcomes, which may lay a theoretical foundation on the personalized management of blood pressure in ICH patients.Methods: Forty-three acute supratentorial ICH patients(53.7 ± 10.0 years old, 30 men) were enrolled for serial measurements performed on days 1~2, 4~6, 10~12, and 30 days after ictus. Non-invasive continuous cerebral blood flow velocity(CBFV) and arterial blood pressure were recorded simultaneously using a transcranial Doppler device and a servo-controlled plethysmograph, respectively. Transfer function analysis was used to derive the autoregulatory parameters including phase difference(PD), gain, and the rate of recovery of CBFV. Results were compared with healthy controls and correlated with clinical factors and the 90-day outcome.Results: PD did not differ between affected and unaffected hemispheres over time. A significant lower PD(indicating d CA impaired) was found in bilateral hemispheres on days 1~2, 4~6 and 10~12, followed by later recovery on day 30. Lower bilateral PD on days 1~2 were associated with poorer Glasgow Coma Scale score at that time. Lower affected side PD on days 4~6 was an independent predictive value for a poorer modified Rankin Scale at 90 days.Conclusions: In patients with supratentorial ICH, d CA is bilaterally impaired lasting at least 10~12 days and recovers within a month. Lower individual PD value is associated with poorer Glasgow Coma Scale at acute stage, and affected side PD on days 4~6 can be an independent predictor for clinical outcome. |
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