Chronological changes in CBF autoregulation with relation to parasympathetic nervous function in hemispheric cerebrovascular disease
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It is well known that the autoregulation of cerebral blood flow (CBF) is impaired in cerebrovascular disease (CVD). In addition, it is recognized that the autonomic nervous system plays an important role in the regulatory mechanism of CBF autoregulation. We have already reported the fluctuations of the autonomic nervous function in CVD, especially in its acute stage. However, no systematic evaluations of the relations between the time course of CBF autoregulation and autonomic nervous function have been attempted yet.<BR>The present study was designed to investigate the dynamic changes in the time course of CBF autoregulation with relation to the autonomic nervous function.<BR>The subjects of the present study were forty-two patients with hemisheric CVD except for cases with severe loss of consciousness and sixty normal controls.<BR>CBF was estimated by using the method of cerebral arterio-venous oxygen difference. Changes in cerebral perfusion pressure were induced by head-up tilt method.<BR>CBF autoregulation was quantitatively analyzed by means of dysautoregulation index, in other words, the ratio of changes in CBF was divided by changes in cerebral perfusion pressure. <BR>The autonomic nervous functions were examined by using hemodynamic functional tests with simultaneous recordings of blood pressure, pulse rate and respiration.<BR>Time course of CBF autoregulation was calculated by using high degree regression analysis. <BR>The dysautoregulation indices, which were high immediately after the onset, decreased towards normal from the first to the fourth day. They moved higher from the fifth to the twelfth day, and returned towards lower values after the thirteenth day.<BR>The degree of reflex bradycardia in Aschner's test, which is a parameter of the parasympathetic function, moved towards normal immediately after the onset. But, it had a poor response from the fifth day to the twelfth day, then once more it slowly returned towards normal after the thirteenth day. On the other hand, the time course of reflex hypertension in the cold pressor test, which is a parameter of the sympathetic function, showed abnormally high values on sixth and twentieth day after the onset.<BR>Secondly, the relation of CBF autoregulation to autonomic functions were investigated in the cases with acute CVD. Aschner's test showed a poor response in the cases where the dysautoregulation indices had abnormally high values. In contrast to this, Aschner's test had a good response in the cases where the dysautoregulation indices were normal. On the other hand, the time course of reflex hypertension in the cold pressor test did not show any close connection with CBF autoregulation in acute CVD.<BR>The above data suggest that the parasympathetic nervous function has a strong correlation with CBF autorevulation.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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