Lang E W, Mehdorn H M, Dorsch N W C, Czosnyka M
Department of Neurosurgery, Christian-Albrechts-Universität, Weimarer Strasse 8, D-24106 Kiel, Germany.
J Neurol Neurosurg Psychiatry. 2002 May;72(5):583-6. doi: 10.1136/jnnp.72.5.583.
Continuous monitoring of dynamic cerebral autoregulation, using a moving correlation index of cerebral perfusion pressure and mean middle cerebral artery flow velocity, may be useful in patients with severe traumatic brain injury to guide treatment, and has been shown to be of prognostic value.
To compare an index of dynamic cerebral autoregulation (Mx) with an index of static cerebral autoregulation (sRoR).
Mx was validated in a prospective comparative study against sRoR, using 83 testing sessions in 17 patients with traumatic brain injury. sRoR and Mx were calculated simultaneously during pharmacologically induced blood pressure variations.
Mx was significantly correlated with sRoR (R = -0.78, p < 0.05). Nine patients were found to have failure of cerebral autoregulation, with an sRoR value < 50%. If an Mx value of 0.3 was used as the cut off point for failure of cerebral autoregulation, this index had 100% sensitivity and 90% specificity for demonstrating failure of autoregulation compared with the sRoR. An increase in cerebral blood flow velocity correlated significantly with Mx (R = 0.73, p < 0.05) but not with cerebral perfusion pressure (R = 0.41).
Dynamic and static cerebral autoregulation are significantly correlated in traumatic brain injury. Cerebral autoregulation can be monitored continuously, graded, and reliably assessed using a moving correlation analysis of cerebral perfusion pressure and cerebral blood flow velocity (Mx). The Mx index can be used to monitor cerebral blood flow regulation. It is useful in traumatic brain injury because it does not require any external stimulus.
使用脑灌注压与大脑中动脉平均血流速度的移动相关指数对动态脑自动调节进行连续监测，可能有助于指导重型创伤性脑损伤患者的治疗，并且已显示具有预后价值。
比较动态脑自动调节指数（Mx）与静态脑自动调节指数（sRoR）。
在一项前瞻性比较研究中，针对17例创伤性脑损伤患者进行了83次测试，将Mx与sRoR进行验证。在药物诱导的血压变化期间同时计算sRoR和Mx。
Mx与sRoR显著相关（R = -0.78，p < 0.05）。发现9例患者脑自动调节功能衰竭，sRoR值<50%。如果将Mx值0.3用作脑自动调节功能衰竭的截断点，则该指数在显示自动调节功能衰竭方面与sRoR相比具有100%的敏感性和90%的特异性。脑血流速度增加与Mx显著相关（R = 0.73，p < 0.05），但与脑灌注压无关（R = 0.41）。
在创伤性脑损伤中，动态和静态脑自动调节显著相关。使用脑灌注压和脑血流速度的移动相关分析（Mx）可以连续、分级并可靠地评估脑自动调节。Mx指数可用于监测脑血流调节。它在创伤性脑损伤中很有用，因为它不需要任何外部刺激。
