Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India.
Curr Opin Anaesthesiol. 2011 Oct;24(5):487-94. doi: 10.1097/ACO.0b013e32834a8965.
Cerebral ischemia forms the pathophysiological basis of several acute neurological conditions. Successful management of these conditions depends on early and accurate identification of ischemia and prompt treatment. Several techniques of assessing ischemia have evolved over decades. But their importance in the management of neurological patients remains ambiguous.
Current trends in monitoring cerebral ischemia follow two pathways: (1) Indirect methods of assessing global and regional cerebral perfusion [intracranial pressure/cerebral perfusion pressure (ICP/CPP), transcranial Doppler]; and (2) Assessment of adequacy of cerebral blood flow (CBF) at tissue level by monitoring global or regional oxygenation and metabolism (SjvO2, rSO2, PbtO2, microdialysis).Traditional approach to ICP/CPP monitoring has changed to more complex analysis of the ICP waveform to derive variables related to cerebral perfusion and vascular reactivity. Noninvasive techniques of cerebral perfusion pressure assessment are under investigation. Newer methods are being explored to derive indices of CBF autoregulation from various modalities of cerebral monitoring. Direct brain tissue oxygen tension monitoring and microdialysis facilitate regional monitoring of oxidative metabolism. However, there seems to be some complexity in interpreting the results from these monitors.
A wide range of options are available for monitoring adequacy of regional and global CBF. But no single monitor per se fulfils the requirements of all clinical situations. Impact of these monitors on clinical outcomes is equivocal. Also, at present, many of these monitors are invasive and not cost-effective.
脑缺血是多种急性神经疾病的病理生理基础。这些疾病的成功治疗取决于早期准确识别缺血并及时治疗。几十年来，已经发展出了几种评估脑缺血的技术。但它们在神经科患者管理中的重要性仍存在争议。
目前监测脑缺血的趋势有两种途径：（1）评估全脑和局部脑灌注的间接方法[颅内压/脑灌注压（ICP/CPP）、经颅多普勒]；（2）通过监测全脑或局部氧合和代谢（SjvO2、rSO2、PbtO2、微透析）来评估脑血流（CBF）的充足性。传统的 ICP/CPP 监测方法已转变为对 ICP 波形进行更复杂的分析，以得出与脑灌注和血管反应性相关的变量。脑灌注压评估的非侵入性技术正在研究中。新的方法正在探索中，以便从各种脑监测模式中得出 CBF 自动调节指数。直接脑组织氧张力监测和微透析有助于局部监测氧化代谢。然而，这些监测器的结果似乎存在一定的复杂性。
有多种监测局部和全脑 CBF 充足性的选择。但没有任何单一的监测器本身就能满足所有临床情况的要求。这些监测器对临床结果的影响尚无定论。此外，目前，这些监测器中的许多都是有创的，而且不具有成本效益。
