Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Curr Opin Anaesthesiol. 2011 Apr;24(2):131-7. doi: 10.1097/ACO.0b013e3283445898.
Cerebral ischemia plays a major role in the pathophysiology of the injured brain, including traumatic brain injury and subarachnoid hemorrhage, thus improvement in outcome may necessitate monitoring and optimization of cerebral blood flow (CBF). To interpret CBF results in a meaningful way, it may be necessary to quantify cerebral autoregulation as well as cerebral metabolism. This review addresses the recent evidence related to the changes in CBF and its monitoring/management in traumatic brain injury.
Recent evidence on the management of patients with traumatic brain injury have focused on the importance of cerebral autoregulation in maintaining perfusion, which necessitates the measurement of CBF. However, adequate CBF measurements alone would not indicate the amount of oxygen delivered to neuronal tissues. Technologic advancements in measurement devices have enabled the assessment of the metabolic state of the cerebral tissue for the purpose of guiding therapy, progress as well as prognostification.
Current neurocritical care management strategies are focused on the prevention and limitation of secondary brain injury where neuronal insult continues to evolve during the hours and days after the primary injury. Appropriately chosen multimodal monitoring including CBF and management measures can result in reduction in mortality and morbidity.
脑缺血在损伤性脑疾病（包括创伤性脑损伤和蛛网膜下腔出血）的病理生理学中起着重要作用，因此，改善预后可能需要监测和优化脑血流（CBF）。为了以有意义的方式解释 CBF 结果，可能需要量化脑自动调节和脑代谢。这篇综述讨论了与创伤性脑损伤中 CBF 变化及其监测/管理相关的最新证据。
最近关于创伤性脑损伤患者管理的证据集中在脑自动调节在维持灌注中的重要性上，这需要测量 CBF。然而，仅足够的 CBF 测量并不能表明输送到神经元组织的氧气量。测量设备的技术进步使评估脑组织的代谢状态成为可能，目的是指导治疗、进展和预后。
目前的神经危重病管理策略集中在预防和限制继发性脑损伤上，继发性脑损伤在原发性损伤后数小时和数天内仍在继续发展。适当选择包括 CBF 和管理措施的多模式监测可降低死亡率和发病率。
