Scheeren Thomas W L, Saugel Bernd
Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
J Clin Monit Comput. 2017 Apr;31(2):241-246. doi: 10.1007/s10877-017-9980-7. Epub 2017 Jan 24.
In the perioperative and critical care setting, monitoring of cerebral oxygenation (ScO) and cerebral autoregulation enjoy increasing popularity in recent years, particularly in patients undergoing cardiac surgery. Monitoring ScO is based on near infrared spectroscopy, and attempts to early detect cerebral hypoperfusion and thereby prevent cerebral dysfunction and postoperative neurologic complications. Autoregulation of cerebral blood flow provides a steady flow of blood towards the brain despite variations in mean arterial blood pressure (MAP) and cerebral perfusion pressure, and is effective in a MAP range between approximately 50-150 mmHg. This range of intact autoregulation may, however, vary considerably between individuals, and shifts to higher thresholds have been observed in elderly and hypertensive patients. As a consequence, intraoperative hypotension will be poorly tolerated, and might cause ischemic events and postoperative neurological complications. This article summarizes research investigating technologies for the assessment of ScO and cerebral autoregulation published in the Journal of Clinical Monitoring and Computing in 2016.
在围手术期和重症监护环境中,近年来对脑氧合(ScO)和脑自动调节功能的监测越来越受到关注,尤其是在接受心脏手术的患者中。ScO监测基于近红外光谱技术,旨在早期发现脑灌注不足,从而预防脑功能障碍和术后神经并发症。尽管平均动脉血压(MAP)和脑灌注压存在变化,但脑血流自动调节功能可确保稳定的脑血流供应,在大约50 - 150 mmHg的MAP范围内有效。然而,这一自动调节功能完好的范围在个体之间可能有很大差异,并且在老年和高血压患者中已观察到自动调节阈值向更高值偏移。因此,术中低血压的耐受性较差,可能会导致缺血事件和术后神经并发症。本文总结了2016年发表在《临床监测与计算杂志》上的关于评估ScO和脑自动调节功能技术的研究。