aDepartment of Neurosurgery, University of Cincinnati (UC) College of Medicine bMayfield Clinic, Cincinnati, Ohio, USA.
Curr Opin Crit Care. 2017 Apr;23(2):94-102. doi: 10.1097/MCC.0000000000000395.
Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential.
Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction. The signatures of such deterioration are observed in electrocorticographic recordings from perilesional cortex of patients with acute stroke or brain trauma. Experimental work suggests that depolarizations are triggered by energy supply-demand mismatch in focal hotspots of the injury penumbra, and depolarizations are usually observed clinically when other monitoring variables are within recommended ranges. These results suggest that depolarizations are a sensitive measure of relative ischemia and ongoing secondary injury, and may serve as a clinical guide for personalized, mechanistically targeted therapy. Both existing and future candidate therapies offer hope to limit depolarization recurrence.
Electrocorticographic monitoring of spreading depolarizations in patients with acute brain injury provides a sensitive measure of relative energy shortage in focal, vulnerable brains regions and indicates ongoing secondary damage. Depolarization monitoring holds potential for targeted clinical trial design and implementation of precision medicine approaches to acute brain injury therapy.
扩布性去极化是独特的病理实体，在实验中得到了很好的描述，并且在有大量急性脑损伤的患者中也很常见。在这里，我们回顾了去极化监测的基本概念，强调了其临床意义、解释和未来的潜力。
在不同的动物模型中，皮质损伤的发展是由广泛的去极化组织波介导的，这些去极化波导致离子动态平衡的毒性丧失，并通过相关的血管收缩限制能量底物的供应。在急性中风或脑外伤患者的皮层下皮层的脑电描记记录中可以观察到这种恶化的特征。实验工作表明，去极化是由损伤半影的局灶热点中的能量供应-需求不匹配触发的，并且当其他监测变量在推荐范围内时，临床上通常会观察到去极化。这些结果表明，去极化是相对缺血和进行性继发性损伤的敏感指标，并可能作为个性化、针对机制的治疗的临床指导。现有的和未来的候选治疗方法都为限制去极化复发提供了希望。
在急性脑损伤患者中进行扩布性去极化的脑电监测提供了一种敏感的方法来测量局灶性、脆弱脑区的相对能量不足，并表明存在持续的继发性损伤。去极化监测有可能为靶向临床试验设计和实施急性脑损伤治疗的精准医学方法提供指导。
