Rose Jack C, Neill Terry A, Hemphill J Claude
Neurovascular Service, University of California, San Francisco, California 94110, USA.
Curr Opin Crit Care. 2006 Apr;12(2):97-102. doi: 10.1097/01.ccx.0000216574.26686.e9.
This article summarizes recent clinical and experimental studies of parenchymal brain tissue oxygen monitoring and considers future directions for its use in neurocritical care.
Recent reports have focused on the relationship between brain tissue oxygen tension (PbrO2) and other physiologic parameters such as mean arterial pressure, cerebral perfusion pressure, cerebral blood flow, and fraction of inspired oxygen. PbrO2 appears to reflect both regional and systemic oxygen concentrations as well as microvascular perfusion through natural tissue gradients. Defining an absolute critically low PbrO2 threshold has been challenging, but levels below 14 mmHg may have a pathophysiologic basis. Newer studies have examined dynamic changes in PbrO2 during oxygen reactivity testing and during augmentation of cerebral perfusion pressure. PbrO2 monitoring has now been described in a wide range of neurocritical care conditions including head trauma, subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage, brain death, and brain tumor resection.
The use of brain tissue oxygen monitoring is maturing as a tool to detect and treat secondary brain injury. PbrO2 measurements can provide continuous quantitative data about injury pathophysiology and severity that may help optimize neurointensive care management. Prospective trials of PbrO2 guided treatment protocols are now needed to demonstrate impact on clinical outcomes.
本文总结了近期脑实质组织氧监测的临床和实验研究，并探讨了其在神经重症监护中应用的未来方向。
近期报告聚焦于脑组织氧分压（PbrO2）与其他生理参数之间的关系，如平均动脉压、脑灌注压、脑血流量和吸入氧分数。PbrO2似乎通过自然组织梯度反映局部和全身氧浓度以及微血管灌注。确定绝对的极低PbrO2阈值具有挑战性，但低于14 mmHg的水平可能具有病理生理学基础。新的研究已考察了氧反应性测试期间及脑灌注压升高期间PbrO2的动态变化。现已报道PbrO2监测可用于多种神经重症监护情况，包括头部创伤、蛛网膜下腔出血、非创伤性脑出血、脑死亡和脑肿瘤切除术。
脑组织氧监测作为一种检测和治疗继发性脑损伤的工具正在不断成熟。PbrO2测量可提供有关损伤病理生理学和严重程度的连续定量数据，这可能有助于优化神经重症监护管理。目前需要进行PbrO2指导治疗方案的前瞻性试验，以证明其对临床结局的影响。
