1 Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
2 Department of Neurosurgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
J Neurotrauma. 2019 May 15;36(10):1491-1504. doi: 10.1089/neu.2018.6073. Epub 2019 Jan 28.
The quantification and objective documentation of autonomic dysfunction in traumatic brain injury (TBI) is neither well studied nor extensively validated. Most of the descriptions of autonomic dysfunction in the literature are in the form of vague non-specific clinical manifestations. Few studies propose the use of objective measures of assessing the extent of autonomic dysfunction to link them to the outcome of TBI. Our goal was to perform a scoping systematic review of the literature on the objective documentation of autonomic dysfunction in terms of functional and physiological variables to be linked to outcome of TBI. PubMed/MEDLINE, BIOSIS, Scopus, Embase, Cochrane Libraries, and Global Health databases were searched. Two reviewers independently screened the results. Full texts for citations passing this initial screen were obtained. Inclusion and exclusion criteria were applied to each article to obtain final articles for review. The initial search yielded 2619 citations. Of 69 articles selected for final review, 14 were chosen based on the inclusion and exclusion criteria and are included in the results of this article. 9 of these articles assessed autonomic dysfunction using functional variables and 7 assessed autonomic dysfunction using physiological variables. Some studies included both functional and physiological variables. Of the nine studies linking autonomic dysfunction to functional variables, nine included heart rate variability (HRV), three included baroreflex sensitivity (BRS), and two included blood pressure variability (BPV). A total of 2714 adult patients were studied. Although the nature of association between autonomic dysfunction and outcome is unclear, the objective quantification of autonomic dysfunction seems to be associated with global patient outcome and other neurophysiological measures. Further studies are needed to validate its use and explore the underlying molecular mechanisms of the described associations.
颅脑创伤(TBI)患者自主神经功能障碍的量化和客观记录既缺乏深入研究也未得到广泛验证。文献中对自主神经功能障碍的描述大多是模糊的非特异性临床表现。少数研究提出使用客观测量来评估自主神经功能障碍的程度,并将其与 TBI 的结果联系起来。我们的目标是对关于 TBI 结果相关的自主神经功能障碍的功能和生理变量的客观记录的文献进行范围广泛的系统综述。检索了 PubMed/MEDLINE、BIOSIS、Scopus、Embase、Cochrane 图书馆和全球健康数据库。两名审查员独立筛选结果。通过此初始筛选的引用的全文均已获得。对每篇文章应用纳入和排除标准,以获得最终的综述文章。最初的搜索产生了 2619 条引文。在 69 篇被选为最终综述的文章中,有 14 篇是根据纳入和排除标准选择的,并包含在本文的结果中。其中 9 篇文章使用功能变量评估自主神经功能障碍,7 篇文章使用生理变量评估自主神经功能障碍。一些研究同时包含功能和生理变量。在将自主神经功能障碍与功能变量联系起来的九项研究中,有九项研究包括心率变异性(HRV),三项研究包括血压反射敏感性(BRS),两项研究包括血压变异性(BPV)。共有 2714 名成年患者接受了研究。尽管自主神经功能障碍与结果之间的关联性质尚不清楚,但自主神经功能障碍的客观量化似乎与患者整体预后和其他神经生理测量有关。需要进一步的研究来验证其使用并探索所描述关联的潜在分子机制。