Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
J Neurosurg Anesthesiol. 2011 Jan;23(1):41-4. doi: 10.1097/ANA.0b013e3181f35854.
In patients with neuronal injury, the knowledge of the status of cerebrovascular autoregulation can help to optimize the management of the cerebral perfusion pressure. This study characterizes dynamic and static cerebrovascular autoregulation during the first 7 days after severe traumatic brain injury or intracranial hemorrhage.
After approval from the IRB, 16 patients were studied. Cerebral blood flow velocity (CBFV) was measured daily for the assessment of dynamic (10 patients) and static (16 patients) cerebrovascular autoregulation in both the middle cerebral arteries using the transcranial Doppler sonography. Dynamic cerebrovascular autoregulation (dAR) was measured using the cuff-deflation method and was expressed by the index of the dAR. The index of the static cerebrovascular autoregulation (sAR) was calculated from changes in the CBFV in relation to drug-induced alterations of the arterial blood pressure. For statistical analyses, t test and mixed effect model were used.
Both dAR and sAR after brain injury were impaired in most of the patients. The chronologic sequence of the dAR at the ipsilateral injured hemisphere showed a significant decrease until day 4 followed by an incomplete recovery (P < 0.002). Changes in sAR were similar, however, they did not gain statistical significance. CBFV was lower at day 1-2 after injury in comparison with day 4 to 7 (P < 0.02).
Daily measured dAR and sAR were impaired after brain injury with a nadir on day 4 and consecutive incomplete recovery over time.
在神经元损伤患者中，了解脑血管自动调节状态有助于优化脑灌注压管理。本研究描述了严重创伤性脑损伤或颅内出血后前 7 天的脑血管自动调节的动态和静态变化。
在获得机构审查委员会批准后，研究了 16 名患者。使用经颅多普勒超声每天测量大脑中动脉的脑血流速度（CBFV），以评估动态（10 名患者）和静态（16 名患者）脑血管自动调节。使用袖带放气法测量动态脑血管自动调节（dAR），并通过 dAR 指数表示。静态脑血管自动调节（sAR）指数是通过 CBFV 与药物诱导的动脉血压变化之间的关系计算得出的。进行统计分析时使用了 t 检验和混合效应模型。
大多数患者在脑损伤后 dAR 和 sAR 均受损。同侧受伤半球的 dAR 时间序列显示，直到第 4 天，其显著下降，随后不完全恢复（P < 0.002）。sAR 的变化相似，但未达到统计学意义。与第 4 至 7 天相比，伤后第 1 至 2 天的 CBFV 较低（P < 0.02）。
脑损伤后，每日测量的 dAR 和 sAR 受损，第 4 天达到最低点，随后逐渐不完全恢复。
