Cardiovascular Systems Laboratory, Centre for Translational Physiology, University of Otago, 23A Mein Street, PO Box 7343, Wellington South, New Zealand,
Eur J Appl Physiol. 2014 Mar;114(3):545-59. doi: 10.1007/s00421-013-2667-y. Epub 2013 Jun 5.
Cerebral autoregulation (CA) is integral to the delicate process of maintaining stable cerebral perfusion and brain tissue oxygenation against changes in arterial blood pressure. The last four decades has seen dramatic advances in understanding CA physiology, and the role that CA might play in the causation and progression of disease processes that affect the cerebral circulation such as stroke. However, the translation of these basic scientific advances into clinical practice has been limited by the maintenance of old constructs and because there are persistent gaps in our understanding of how this vital vascular mechanism should be quantified. In this review, we re-evaluate relevant studies that challenge established paradigms about how the cerebral perfusion pressure and blood flow are related. In the context of blood pressure being a major haemodynamic challenge to the cerebral circulation, we conclude that: (1) the physiological properties of CA remain inconclusive, (2) many extant methods for CA characterisation are based on simplistic assumptions that can give rise to misleading interpretations, and (3) robust evaluation of CA requires thorough consideration not only of active vasomotor function, but also the unique properties of the intracranial environment.
脑自动调节（CA）对于维持稳定的脑灌注和脑组织氧合至关重要，可对抗动脉血压的变化。在过去的四十年中，人们对 CA 生理学有了深刻的认识，并且了解到 CA 在影响脑循环的疾病过程（如中风）的发病和进展中可能发挥的作用。然而，这些基础科学的进步转化为临床实践受到了限制，原因是人们仍然对这种重要的血管机制应该如何进行量化存在理解上的差距，并且旧有的观念依然存在。在这篇综述中，我们重新评估了挑战有关脑灌注压和血流量之间关系的既定模式的相关研究。在血压是对脑循环的主要血流动力学挑战的背景下，我们得出结论：（1）CA 的生理特性仍不确定，（2）许多现有的 CA 特征描述方法都是基于可能产生误导性解释的简单假设，（3）对 CA 的稳健评估不仅需要彻底考虑主动血管运动功能，还需要充分考虑颅内环境的独特特性。
