Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK.
Int J Mol Sci. 2021 Jan 23;22(3):1122. doi: 10.3390/ijms22031122.
The brain tissue partial oxygen pressure (PbtO) and near-infrared spectroscopy (NIRS) neuromonitoring are frequently compared in the management of acute moderate and severe traumatic brain injury patients; however, the relationship between their respective output parameters flows from the complex pathogenesis of tissue respiration after brain trauma. NIRS neuromonitoring overcomes certain limitations related to the heterogeneity of the pathology across the brain that cannot be adequately addressed by local-sample invasive neuromonitoring (e.g., PbtO neuromonitoring, microdialysis), and it allows clinicians to assess parameters that cannot otherwise be scanned. The anatomical co-registration of an NIRS signal with axial imaging (e.g., computerized tomography scan) enhances the optical signal, which can be changed by the anatomy of the lesions and the significance of the radiological assessment. These arguments led us to conclude that rather than aiming to substitute PbtO with tissue saturation, multiple types of NIRS should be included via multimodal systemic- and neuro-monitoring, whose values then are incorporated into biosignatures linked to patient status and prognosis. Discussion on the abnormalities in tissue respiration due to brain trauma and how they affect the PbtO and NIRS neuromonitoring is given.
脑组织局部氧分压（PbtO）和近红外光谱（NIRS）神经监测在急性中重度创伤性脑损伤患者的管理中经常被比较；然而，它们各自的输出参数之间的关系源于脑外伤后组织呼吸的复杂发病机制。NIRS 神经监测克服了局部样本侵入性神经监测（如 PbtO 神经监测、微透析）无法充分解决的与大脑病理学异质性相关的某些局限性，并且它允许临床医生评估无法扫描的参数。NIRS 信号与轴向成像（例如计算机断层扫描）的解剖配准增强了光学信号，该信号可被病变的解剖结构和放射学评估的意义改变。这些观点使我们得出结论，即不应该将 PbtO 与组织饱和度进行替代，而是应该通过多模态系统和神经监测来包含多种类型的 NIRS，然后将其值纳入与患者状态和预后相关的生物标志物中。讨论了脑外伤引起的组织呼吸异常以及它们如何影响 PbtO 和 NIRS 神经监测。
