Prabhakar Hemanshu, Sandhu Kavita, Bhagat Hemant, Durga Padmaja, Chawla Rajiv
Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, PGIMER, Chandigarh, India.
Department of Neuroanaesthesiology and Critical Care, Max Superspeciality Hospital, PGIMER, Chandigarh, India.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):318-27. doi: 10.4103/0970-9185.137260.
Traumatic brain injury (TBI) consists of varied pathophysiological consequences and alteration of intracranial dynamics, reduction of the cerebral blood flow and oxygenation. In the past decade more emphasis has been directed towards optimizing cerebral perfusion pressure (CPP) in patients who have suffered TBI. Injured brain may show signs of ischemia if CPP remains below 50 mmHg and raising the CPP above 60 mmHg may avoid cerebral oxygen desaturation. Though CPP above 70 mmHg is influential in achieving an improved patient outcome, maintenance of CPP higher than 70 mmHg was associated with greater risk of acute respiratory distress syndrome (ARDS). The target CPP has been laid within 50-70 mmHg. Cerebral blood flow and metabolism are heterogeneous after TBI and with regional temporal differences in the requirement for CPP. Brain monitoring techniques such as jugular venous oximetry, monitoring of brain tissue oxygen tension (PbrO2), and cerebral microdialysis provide complementary and specific information that permits the selection of the optimal CPP. This review highlights the rationale for use CPP directed therapies and neuromonitoring to identify optimal CPP of head injured patients. The article also reviews the evidence provided by various clinical trials regarding optimal CPP and their application in the management of head injured patients.
创伤性脑损伤（TBI）包括多种病理生理后果以及颅内动力学改变、脑血流量和氧合作用降低。在过去十年中，更多的重点放在了优化TBI患者的脑灌注压（CPP）上。如果CPP持续低于50 mmHg，受伤的大脑可能会出现缺血迹象，而将CPP提高到60 mmHg以上可能会避免脑氧饱和度降低。尽管CPP高于70 mmHg对改善患者预后有影响，但维持CPP高于70 mmHg与急性呼吸窘迫综合征（ARDS）的风险增加有关。目标CPP设定在50 - 70 mmHg之间。TBI后脑血流量和代谢是不均匀的，且对CPP的需求存在区域和时间差异。脑监测技术，如颈静脉血氧饱和度测定、脑组织氧分压（PbrO2）监测和脑微透析，提供了互补的特定信息，有助于选择最佳的CPP。本综述强调了使用CPP导向治疗和神经监测来确定头部受伤患者最佳CPP的基本原理。本文还回顾了各种临床试验提供的关于最佳CPP的证据及其在头部受伤患者管理中的应用。
