Froese Logan, Dian Joshua, Gomez Alwyn, Unger Bertram, Zeiler Frederick A
Biomedical Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Neurotrauma Rep. 2020 Jul 23;1(1):46-62. doi: 10.1089/neur.2020.0008. eCollection 2020.
Intravenous phenylephrine (PE) is utilized commonly in critical care for cardiovascular support. Its impact on the cerebrovasculature is unclear and its use may have important implications during states of critical neurological illness. The aim of this study was to perform a scoping review of the literature on the cerebrovascular/cerebral blood flow (CBF) effects of PE in traumatic brain injury (TBI), evaluating both animal models and human studies. We searched MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and the Cochrane Library from inception to January 2020. We identified 12 studies with various animal models and 4 studies in humans with varying TBI pathology. There was a trend toward a consistent increase in mean arterial pressure (MAP) by the injection of PE systemically, and by proxy, an increase of the cerebral perfusion pressure (CPP). There was a consistent constriction of cerebral vessels by PE reported in the small number of studies documenting such a response. However, the heterogeneity of the literature on the CBF/cerebral blood volume (CBV) response makes the strength of the conclusions on PE limited. Studies were heterogeneous in design and had significant limitations, with most failing to adjust for confounding factors in cerebrovascular/CBF response. This review highlights the significant knowledge gap on the cerebrovascular/CBF effects of PE administration in TBI, calling for further study on the impact of PE on the cerebrovasculature both and in experimental settings.
静脉注射去氧肾上腺素（PE）常用于重症监护中进行心血管支持。其对脑血管系统的影响尚不清楚，在重症神经疾病状态下使用可能具有重要意义。本研究的目的是对关于PE对创伤性脑损伤（TBI）脑血管/脑血流量（CBF）影响的文献进行范围综述，评估动物模型和人体研究。我们检索了从创刊到2020年1月的MEDLINE、BIOSIS、EMBASE、全球健康、SCOPUS和Cochrane图书馆。我们确定了12项使用各种动物模型的研究和4项针对不同TBI病理的人体研究。全身注射PE后平均动脉压（MAP）有持续升高的趋势，相应地，脑灌注压（CPP）也升高。在少数记录了这种反应的研究中，PE导致脑血管持续收缩。然而，关于CBF/脑血容量（CBV）反应的文献异质性使得关于PE的结论的力度有限。研究在设计上存在异质性且有显著局限性，大多数研究未能对脑血管/CBF反应中的混杂因素进行调整。本综述突出了关于TBI中PE给药对脑血管/CBF影响的重大知识空白，呼吁进一步研究PE在临床和实验环境中对脑血管系统的影响。
