Czosnyka M, Smielewski P, Piechnik S, Pickard J D
Academic Neurosurgical Unit, Addenbrooke's Hospital, Cambridge, UK.
Acta Neurochir Suppl. 2002;81:117-9. doi: 10.1007/978-3-7091-6738-0_30.
Disturbed cerebral autoregulation is believed to be associated with an unfavourable outcome following head injury. Previously, using ICP monitoring and transcranial Doppler ultrasonography, we investigated whether cerebral response to spontaneous variations in arterial pressure (ABP) or cerebral perfusion pressure (CPP) provide reliable information on cerebral autoregulatory reserve. In the present study we have correlated these methods with clinical findings.
188 head injured sedated and ventilated patients were studied daily. Waveforms of intracranial pressure (ICP), arterial pressure and transcranial Doppler flow velocity (FV) were captured over a half to two hour periods. Time averaged mean flow velocity (FV) and CPP were resolved. The correlation coefficient indices between FV and CPP (Mx) and between ICP and ABP (PRx) were calculated over 3 minutes epochs, and averaged for each investigation.
The relationship between indices of autoregulation and outcome (favourable-unfavourable) was significant and stronger than the association between admission GCS and outcome. With rigorously maintained CPP-oriented therapy relationship between CPP and outcome became non-significant. Mortality in patients with consistently disturbed autoregulation ranged 47%, while in patients with good autoregulation mortality was 11% (difference: p < 0.0001).
Positive values of indices of autoregulation, expressing positive association between slow waves of CPP and blood flow velocity or ABP and ICP, indicate disturbed autoregulation. These indices correlate with unfavourable outcome following head injury and should be used to guide intensive therapy.
脑自动调节功能紊乱被认为与头部受伤后的不良预后相关。此前，我们通过颅内压监测和经颅多普勒超声检查，研究了大脑对动脉血压（ABP）或脑灌注压（CPP）自发变化的反应是否能提供有关脑自动调节储备的可靠信息。在本研究中，我们将这些方法与临床发现进行了关联。
每天对188例头部受伤且接受镇静和通气治疗的患者进行研究。在半小时至两小时的时间段内采集颅内压（ICP）、动脉血压和经颅多普勒血流速度（FV）的波形。计算时间平均平均血流速度（FV）和CPP。在3分钟的时间段内计算FV与CPP之间（Mx）以及ICP与ABP之间（PRx）的相关系数指数，并对每次检查进行平均。
自动调节指数与预后（良好-不良）之间的关系显著，且比入院时格拉斯哥昏迷量表（GCS）与预后之间的关联更强。在严格维持以CPP为导向的治疗时，CPP与预后之间的关系变得不显著。自动调节功能持续紊乱的患者死亡率为47%，而自动调节功能良好的患者死亡率为11%（差异：p < 0.0001）。
自动调节指数的正值，表明CPP慢波与血流速度或ABP与ICP之间呈正相关，提示自动调节功能紊乱。这些指数与头部受伤后的不良预后相关，应用于指导强化治疗。
