Philip Shaji, Udomphorn Yuthana, Kirkham Fenella J, Vavilala Monica S
Department of Anesthesiology, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA
J Trauma. 2009 Aug;67(2 Suppl):S128-34. doi: 10.1097/TA.0b013e3181ad32c7.
Traumatic brain injury (TBI) is the leading cause of traumatic morbidity and mortality in children. Although there is increasing information concerning TBI in adults and experimental animal models, relatively little is known regarding cerebrovascular pathophysiology specific to children.
A review of the pertinent medical literature.
Systemic and cerebral hemodynamic factors such as hypotension, hypoxia, hyperglycemia, and fever are associated with poor outcome in pediatric TBI. Similarly, cerebral autoregulation is often impaired after TBI and may adversely affect outcome, especially if systemic hemodynamics are altered. Furthermore, CO2 vasoreactivity may be altered after pediatric TBI and lead to either cerebral ischemia or hyperemia.
Understanding the effect of pediatric TBI on the cerebral circulation is needed to potentially develop protocols to improve outcome in this vulnerable population. Specifically, changes in pediatric cerebrovascular physiology and pathophysiology, including CO2 vasoreactivity and pressure autoregulation, must be understood and their mechanism elucidated.
创伤性脑损伤（TBI）是儿童创伤性发病和死亡的主要原因。尽管关于成人和实验动物模型中的TBI信息越来越多，但对于儿童特有的脑血管病理生理学却知之甚少。
对相关医学文献的综述。
低血压、缺氧、高血糖和发热等全身和脑血流动力学因素与小儿TBI的不良预后相关。同样，TBI后大脑自身调节功能常受损，可能对预后产生不利影响，尤其是在全身血流动力学发生改变时。此外，小儿TBI后二氧化碳血管反应性可能改变，导致脑缺血或充血。
需要了解小儿TBI对脑循环的影响，以制定可能改善这一脆弱人群预后的方案。具体而言，必须了解小儿脑血管生理和病理生理学的变化，包括二氧化碳血管反应性和压力自身调节，并阐明其机制。
