目标最佳脑灌注压治疗对创伤性脑损伤患者的获益。

Benefit on optimal cerebral perfusion pressure targeted treatment for traumatic brain injury patients.

机构信息

Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania.

Health Telematics Science Institute, Kaunas University of Technology, Kaunas, Lithuania; Department of Neurology, Academy of Medicine, Lithuanian University of Health Sciences, Lithuania; Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Neurosurgery, Republic Vilnius University Hospital, Vilnius, Lithuania.

出版信息

J Crit Care. 2017 Oct;41:49-55. doi: 10.1016/j.jcrc.2017.04.029. Epub 2017 Apr 23.

DOI:10.1016/j.jcrc.2017.04.029

PMID:28477510

Abstract

PURPOSE

The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBI patients' outcome.

METHODS

The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBI patients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed.

RESULTS

The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0<ΔCPPopt<10mmHg was r=-0.643 (P<0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0<ΔCPPopt<10mmHg was r=-0.587 (P<0.001).

CONCLUSION

The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBI patients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10mmHg above CPPopt) when CPPopt is in the range of 60-80mmHg, and keeping CPP within the range of CPPopt +/-5mmHg when CPPopt is above 80mmHg.

摘要

目的

维持患者特定的最佳脑灌注压（CPPopt）对创伤性脑损伤（TBI）患者至关重要。本研究旨在探讨 CPP 从 CPPopt 值下降对 TBI 患者预后的影响。

方法

对 52 例 TBI 患者进行 CPP 和脑血管自动调节（CA）监测。确定了患者特异性 CPPopt，并分析了患者预后与 CPP 从 CPPopt 值下降的时间、年龄和 CA 损伤发作持续时间的复杂影响之间的关系。

结果

格拉斯哥预后量表（GOS）、CA 损伤事件持续时间和 0<ΔCPPopt<10mmHg 时百分比时间之间的多元相关系数为 r=-0.643（P<0.001）。GOS、年龄和 0<ΔCPPopt<10mmHg 时百分比时间之间的多元相关系数为 r=-0.587（P<0.001）。

结论

针对 CPPopt 的患者特异性管理可能有助于稳定 TBI 患者的 CA，并改善其预后。当 CPPopt 在 60-80mmHg 范围内时，在 CPPopt 以上 10mmHg 的轻度高灌注状态下维持 CPP，当 CPPopt 高于 80mmHg 时保持 CPP 在 CPPopt ±5mmHg 范围内，可以获得更好的结果。