基于经颅多普勒的成人间颅脑损伤脑血管反应性指标:与患者导向结局相关性的范围综述

Transcranial Doppler Based Cerebrovascular Reactivity Indices in Adult Traumatic Brain Injury: A Scoping Review of Associations With Patient Oriented Outcomes.

作者信息

Gomez Alwyn, Froese Logan, Sainbhi Amanjyot Singh, Batson Carleen, Zeiler Frederick A

机构信息

Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

出版信息

Front Pharmacol. 2021 Jul 6;12:690921. doi: 10.3389/fphar.2021.690921. eCollection 2021.

Abstract

Disruption in cerebrovascular reactivity following traumatic brain injury (TBI) is a known phenomenon that may hold prognostic value and clinical relevance. Ultimately, improved knowledge of this process and more robust means of continuous assessment may lead to advances in precision medicine following TBI. One such method is transcranial Doppler (TCD), which has been employed to evaluate cerebrovascular reactivity following injury utilizing a continuous time-series approach. The present study undertakes a scoping review of the literature on the association of continuous time-domain TCD based indices of cerebrovascular reactivity, with global functional outcomes, cerebral physiologic correlates, and imaging evidence of lesion change. Multiple databases were searched from inception to November 2020 for articles relevant to the association of continuous time-domain TCD based indices of cerebrovascular reactivity with global functional outcomes, cerebral physiologic correlates, and imaging evidence of lesion change. Thirty-six relevant articles were identified. There was significant evidence supporting an association with continuous time-domain TCD based indices and functional outcomes following TBI. Indices based on mean flow velocity, as measured by TCD, were most numerous while more recent studies point to systolic flow velocity-based indices encoding more prognostic utility. Physiologic parameters such as intracranial pressure, cerebral perfusion pressure, Carbon Dioxide (CO2) reactivity as well as more established indices of cerebrovascular reactivity have all been associated with these TCD based indices. The literature has been concentrated in a few centres and is further limited by the lack of multivariate analysis. This systematic scoping review of the literature identifies that there is a substantial body of evidence that cerebrovascular reactivity as measured by time-domain TCD based indices have prognostic utility following TBI. Indices based on mean flow velocities have the largest body of literature for their support. However, recent studies indicate that indices based on systolic flow velocities may contain the most prognostic utility and more closely follow more established measures of cerebrovascular reactivity. To a lesser extent, the literature supports some associations between these indices and cerebral physiologic parameters. These indices provide a more complete picture of the patient's physiome following TBI and may ultimately lead to personalized and precise clinical care. Further validation in multi-institution studies is required before these indices can be widely adopted clinically.

摘要

创伤性脑损伤(TBI)后脑血管反应性的破坏是一种已知现象,可能具有预后价值和临床相关性。最终,对这一过程的深入了解以及更强大的连续评估方法可能会推动TBI后精准医学的发展。经颅多普勒(TCD)就是这样一种方法,它已被用于采用连续时间序列方法评估损伤后的脑血管反应性。本研究对基于连续时域TCD的脑血管反应性指标与整体功能结局、脑生理相关性以及病变变化的影像学证据之间的关联进行了文献综述。从数据库建立到2020年11月,对多个数据库进行了搜索,以查找与基于连续时域TCD的脑血管反应性指标与整体功能结局、脑生理相关性以及病变变化的影像学证据之间的关联相关的文章。共识别出36篇相关文章。有大量证据支持基于连续时域TCD的指标与TBI后的功能结局之间存在关联。通过TCD测量的基于平均流速的指标数量最多,而最近的研究指出基于收缩期流速的指标具有更多的预后效用。诸如颅内压、脑灌注压、二氧化碳(CO2)反应性等生理参数以及更成熟的脑血管反应性指标都与这些基于TCD的指标相关。相关文献集中在少数几个中心,并且由于缺乏多变量分析而进一步受限。对文献的这一系统综述表明,有大量证据表明,基于时域TCD的指标所测量的脑血管反应性在TBI后具有预后效用。基于平均流速的指标得到的文献支持最多。然而,最近的研究表明,基于收缩期流速的指标可能包含最多的预后效用,并且更紧密地遵循更成熟的脑血管反应性测量方法。在较小程度上,文献支持这些指标与脑生理参数之间的一些关联。这些指标为TBI后的患者生理组提供了更完整的图景,并可能最终导致个性化和精准的临床护理。在这些指标能够在临床上广泛应用之前,需要在多机构研究中进行进一步验证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/854b/8290494/8793ef275086/fphar-12-690921-g001.jpg

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