Central Hemodynamics and Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders
https://doi.org/10.15360/1813-9779-2009-3-29
Abstract
Objective: to study the central hemodynamics (CH) and intracranial and cerebral perfusion pressures (ICP and CPP) in acute cerebral circulatory disorders (ACCD) and their possible relationships for further development of intensive differential therapy for the detected disorders. Material and methods. Hemodynamic studies using the transpulmonary thermodilu-tion technique, measurements of ICP, calculations of CPP, and currently available X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. All the patients were found to have essential hypertension and coronary heart disease. Results. In the first 5 days of ACCD, there was a normodynamic type of circulation in hemorrhagic stroke (HS) and a hypodynamic type in ischemic stroke (IS). ICP remained at the baseline elevated level in the IS group and increased over time in the HS group. CPP was significantly unchanged. Myocardial dysfunction was detected when there was a significant preload caused by a high postload. In IS, an inverse correlation was found between ICP and global ejection fraction (GEF), cardiac performance index (CPI) and on day 7, the correlation was direct. In HS, ICP had a direct correlation with CPI and an inverse correlation with GEF. These changes during treatment failed to progress and were revealed in the presence of brain dislocation, as evidenced by spiral computed tomography. Conclusion. Thus, the pattern of CH disorders depends on the type of ACCD. In the first 5 days of ACCD, a hypokinetic circulatory type is registered in IS and a normokinetic type is in HS. Evolving dislocation of the brain with impaired function of its stem structures due to ICP elevation is one of the causes of central hemodynamic changes. The value of ICP in ACCD is a crucial indicator in the diagnosis of secondary brain damages and determines treatment policy. Key words: acute ischemic attack, intracranial pressure, cerebral perfusion pressure, central hemodynamics, myocardial depression.
About the Authors
K. V. LukashevA. Z. Valiakhmedov
Yu. A., Churlyaev
L. Yu. Redkokasha
T. I. Borshchikova
P. G. Sitnikov
T. P. Aikina
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Review
For citations:
Lukashev K.V., Valiakhmedov A.Z., Churlyaev Yu.A., Redkokasha L.Yu., Borshchikova T.I., Sitnikov P.G., Aikina T.P. Central Hemodynamics and Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders . General Reanimatology. 2009;5(3):29. (In Russ.) https://doi.org/10.15360/1813-9779-2009-3-29
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