Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK -
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Minerva Anestesiol. 2017 Aug;83(8):844-857. doi: 10.23736/S0375-9393.17.12043-2. Epub 2017 May 12.
Cerebral autoregulation is conceptualized as a vascular self-regulatory mechanism within the brain. Controlled by elusive relationships between various biophysical processes, it functions to protect the brain against potential damages caused by sudden changes in cerebral perfusion pressures and flow. Following events such as traumatic brain injuries (TBI), autoregulation may be compromised, potentially leading to an unfavorable outcome. In spite of its complexity, autoregulation has been able to be quantified non-invasively within the neuro-critical care setting with the aid of transcranial Doppler. This information is interpreted particularly through calculated derived indices based on commonly-monitored input signals such as arterial blood pressure and intracranial pressure (i.e. Pressure Reactivity Index [PRx], Mean Flow Index, etc.). For example, PRx values that trend towards positive numbers are correlated with unfavorable outcome. These predictors are primarily surrogate markers of cerebral hemodynamic activity, although suggesting robust correlations between these indices and patient outcome. This review of the literature seeks to explain the methodology behind the calculations of various measures of autoregulation in adult patients suffering from traumatic brain injuries, and how they can interact with one another to both create larger effects on patient outcome and general outcome prediction models. Insight into the driving forces behind cerebral autoregulation is imperative for guiding both clinical decision-making and global treatment protocols for neuro-critically ill patients. The evidence that autoregulation-oriented therapy may improve outcome after TBI is still oscillating around Level III.
脑自动调节被概念化为大脑内的一种血管自我调节机制。受各种生物物理过程之间难以捉摸的关系控制,它的功能是保护大脑免受脑灌注压和流量突然变化可能造成的损害。在创伤性脑损伤 (TBI) 等事件发生后,自动调节可能会受到影响,可能导致不良后果。尽管它很复杂,但在神经危重症监护环境中,经颅多普勒可以帮助对其进行非侵入性地定量。这些信息主要是通过基于常见监测输入信号(如动脉血压和颅内压)计算得出的衍生指数进行解释,如压力反应性指数 (PRx)、平均流量指数等。例如,趋向正值的 PRx 值与不良预后相关。这些预测因子主要是脑血流动力学活动的替代标志物,尽管这些指数与患者预后之间存在强有力的相关性。这篇文献综述旨在解释在患有创伤性脑损伤的成年患者中计算自动调节各种测量值的方法,以及它们如何相互作用,对患者预后和一般预后预测模型产生更大的影响。深入了解脑自动调节的驱动力对于指导神经危重症患者的临床决策和整体治疗方案至关重要。自动调节导向治疗可能改善 TBI 后预后的证据仍然在 III 级左右波动。
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