Rostami Elham, Nilsson Pelle, Enblad Per
Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
Department of Neuroscience, Karolinska Institute, Stockholm, Sweden.
Front Neurol. 2020 Apr 16;11:274. doi: 10.3389/fneur.2020.00274. eCollection 2020.
Traumatic brain injury is the leading cause of death in children. Children with severe TBI are in need of neurointensive care where the goal is to prevent secondary brain injury by avoiding secondary insults. Monitoring of cerebral blood flow (CBF) and autoregulation in the injured brain is crucial. However, there are limited studies performed in children to investigate this. Current studies report on age dependent increase in CBF with narrow age range. Low initial CBF following TBI has been correlated to poor outcome and may be more prevalent than hyperemia as previously suggested. Impaired cerebral pressure autoregulation is also detected and correlated with poor outcome but it remains to be elucidated if there is a causal relationship. Current studies are few and mainly based on small number of patients between the age of 0-18 years. Considering the changes of CBF and cerebral pressure autoregulation with increasing age, larger studies with more narrow age ranges and multimodality monitoring are required in order to generate data that can optimize the therapy and clinical management of children suffering TBI.
创伤性脑损伤是儿童死亡的主要原因。患有严重创伤性脑损伤的儿童需要神经重症监护，其目标是通过避免二次损伤来预防继发性脑损伤。监测受伤大脑的脑血流量（CBF）和自动调节功能至关重要。然而，针对儿童进行的相关研究有限。目前的研究报告了在狭窄年龄范围内CBF随年龄增长而增加的情况。创伤性脑损伤后初始CBF较低与不良预后相关，且可能比之前认为的充血更为普遍。脑压力自动调节功能受损也被检测到，并且与不良预后相关，但因果关系仍有待阐明。目前的研究较少，主要基于0至18岁的少数患者。考虑到CBF和脑压力自动调节功能随年龄增长的变化，需要进行更大规模、年龄范围更窄且采用多模态监测的研究，以便生成能够优化创伤性脑损伤儿童治疗和临床管理的数据。
