Lang Erhard W, Kasprowicz Magdalena, Smielewski Peter, Pickard John, Czosnyka Marek
Neurosurgical Associates, Red Cross Hospital, Bergmannstrasse 30, Kassel, D-34121, Germany.
Institute of Biomedical Engineering and Instrumentation, Wroclaw University of Technology, Wroclaw, Poland.
Acta Neurochir Suppl. 2016;122:177-9. doi: 10.1007/978-3-319-22533-3_36.
This study investigates 55 intracranial pressure (ICP) plateau waves recorded in 20 patients after severe traumatic brain injury (TBI) with a focus on a moving correlation coefficient between mean arterial pressure (ABP) and ICP, called PRx, which serves as a marker of cerebrovascular reactivity, and a moving correlation coefficient between ABP and cerebral partial pressure of oxygen (pbtO2), called ORx, which serves as a marker for cerebral oxygen reactivity. ICP and ICPamplitude increased significantly during the plateau waves, whereas CPP and pbtO2 decreased significantly. ABP, ABP amplitude, and heart rate remained unchanged. In 73 % of plateau waves PRx increased during the wave. ORx showed an increase during and a decrease after the plateau waves, which was not statistically significant. Our data show profound cerebral vasoparalysis on top of the wave and, to a lesser extent, impairment of cerebral oxygen reactivity. The different behavior of the indices may be due to the different latencies of the cerebral blood flow and oxygen level control mechanisms. While cerebrovascular reactivity is a rapidly reacting mechanism, cerebral oxygen reactivity is slower.
本研究调查了20例重度创伤性脑损伤（TBI）患者记录的55次颅内压（ICP）平台波，重点关注平均动脉压（ABP）与ICP之间的移动相关系数，称为PRx，它作为脑血管反应性的标志物，以及ABP与脑氧分压（pbtO2）之间的移动相关系数，称为ORx，它作为脑氧反应性的标志物。在平台波期间，ICP和ICP振幅显著增加，而脑灌注压（CPP）和pbtO2显著降低。ABP、ABP振幅和心率保持不变。在73%的平台波期间，PRx增加。ORx在平台波期间增加，在平台波后降低，但差异无统计学意义。我们的数据显示在波峰之上存在严重的脑血管麻痹，在较小程度上存在脑氧反应性受损。这些指标的不同表现可能是由于脑血流和氧水平控制机制的不同延迟。虽然脑血管反应性是一种快速反应机制，但脑氧反应性较慢。
