Department of Neurosurgery, Evangelismos Athens General Hospital, Athens, Attica, Greece.
Department of Neurology, Evangelismos Athens General Hospital, Athens, Attica, Greece.
J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):257-261. doi: 10.1055/s-0040-1721682. Epub 2021 Feb 14.
The human brain, depending on aerobic glycolysis to cover its metabolic needs and having no energy reserves whatsoever, relies on a constant and closely regulated blood supply to maintain its structural and functional integrity. Cerebral autoregulation, that is, the brain's intrinsic ability to regulate its own blood flow independently from the systemic blood pressure and cardiac output, is an important physiological mechanism that offers protection from hypoperfusion injury.
Two major independent mechanisms are known to be involved in cerebral autoregulation: (1) flow-metabolism coupling and (2) myogenic responses of cerebral blood vessels to changes in transmural/arterial pressure. A third, less prominent component of cerebral autoregulation comes in the form of neurogenic influences on cerebral vasculature.
Although fragmentation of cerebral autoregulation in separate and distinct from each other mechanisms is somewhat arbitrary, such a scheme is useful for reasons of simplification and to better understand their overall effect. Comprehension of cerebral autoregulation is imperative for clinicians in order for them to mitigate consequences of its impairment in the context of traumatic brain injury, subarachnoid hemorrhage, stroke, or other pathological conditions.
人类大脑依赖于有氧糖酵解来满足其代谢需求，而且没有任何能量储备，因此依赖于稳定且受到密切调节的血液供应来维持其结构和功能的完整性。脑自动调节，即大脑自身独立调节其血流量的能力，不受全身血压和心输出量的影响，是一种重要的生理机制，可以防止低灌注损伤。
有两种主要的独立机制被认为与脑自动调节有关：（1）血流-代谢偶联和（2）脑血管对跨壁/动脉压力变化的肌源性反应。脑自动调节的第三个不太明显的组成部分是对脑血管的神经源性影响。
尽管脑自动调节在不同机制中的碎片化有些任意，但这种方案对于简化和更好地理解其整体效果是有用的。为了减轻创伤性脑损伤、蛛网膜下腔出血、中风或其他病理情况下脑自动调节受损的后果，临床医生必须理解脑自动调节。
