脑搏动性与脑灌注压的关系：使用 CPP 变化的不同驱动因素进行复制验证。
Relationship Between Brain Pulsatility and Cerebral Perfusion Pressure: Replicated Validation Using Different Drivers of CPP Change.
机构信息
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Division of Neuroanesthesia, Department of Anesthesiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
出版信息
Neurocrit Care. 2017 Dec;27(3):392-400. doi: 10.1007/s12028-017-0404-9.
BACKGROUND
Determination of relationships between transcranial Doppler (TCD)-based spectral pulsatility index (sPI) and pulse amplitude (AMP) of intracranial pressure (ICP) in 2 groups of severe traumatic brain injury (TBI) patients (a) displaying plateau waves and (b) with unstable mean arterial pressure (MAP).
METHODS
We retrospectively reviewed patients with severe TBI and continuous TCD monitoring displaying either plateau waves or unstable MAP from 1992 to 1998. We utilized linear and nonlinear regression techniques to describe both cohorts: cerebral perfusion pressure (CPP) versus AMP, CPP versus sPI, mean ICP versus ICP AMP, mean ICP versus sPI, and AMP versus sPI.
RESULTS
Nonlinear regression techniques were employed to analyze the relationships with CPP. In plateau wave and unstable MAP patients, CPP versus sPI displayed an inverse nonlinear relationship (R = 0.820 vs. R = 0.610, respectively), with the CPP versus sPI relationship best modeled by the following function in both cases: PI = a + (b/CPP). Similarly, in both groups, CPP versus AMP displayed an inverse nonlinear relationship (R = 0.610 vs. R = 0.360, respectively). Positive linear correlations were displayed in both the plateau wave and unstable MAP cohorts between: ICP versus AMP, ICP versus sPI, AMP versus sPI.
CONCLUSIONS
There is an inverse relationship through nonlinear regression between CPP versus AMP and CPP versus sPI display. This provides evidence to support a previously-proposed model of TCD pulsatility index. ICP shows a positive linear correlation with AMP and sPI, which is also established between AMP and sPI.
背景
在两组严重创伤性脑损伤（TBI）患者中，分别（a）显示平台波和（b）平均动脉压（MAP）不稳定，确定基于经颅多普勒（TCD）的谱搏动指数（sPI）和颅内压（ICP）脉冲幅度（AMP）之间的关系。
方法
我们回顾性分析了 1992 年至 1998 年期间显示平台波或不稳定 MAP 的严重 TBI 患者且有连续 TCD 监测的患者。我们利用线性和非线性回归技术来描述这两个队列：脑灌注压（CPP）与 AMP、CPP 与 sPI、平均 ICP 与 ICP AMP、平均 ICP 与 sPI 和 AMP 与 sPI。
结果
采用非线性回归技术分析与 CPP 的关系。在平台波和不稳定 MAP 患者中，CPP 与 sPI 呈负非线性关系（R 分别为 0.820 和 0.610），在这两种情况下，CPP 与 sPI 的关系均由以下函数最佳建模：PI=a+(b/CPP)。同样，在两组中，CPP 与 AMP 呈负非线性关系（R 分别为 0.610 和 0.360）。在平台波和不稳定 MAP 队列中，ICP 与 AMP、ICP 与 sPI、AMP 与 sPI 之间均显示出正线性关系。
结论
CPP 与 AMP 和 CPP 与 sPI 之间呈负非线性关系。这为 TCD 搏动指数提出的模型提供了证据。ICP 与 AMP 和 sPI 呈正线性关系，AMP 和 sPI 之间也存在这种关系。
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