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观点对撞：脑灌注压是一个高危概念。

Point-Counterpoint: Cerebral perfusion pressure is a high-risk concept.

机构信息

Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Brazil.

Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.

出版信息

J Cereb Blood Flow Metab. 2023 Nov;43(11):2008-2010. doi: 10.1177/0271678X231198012. Epub 2023 Aug 26.

DOI:10.1177/0271678X231198012
PMID:37632340
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10676146/
Abstract

Cerebral perfusion pressure (CPP) is calculated as the difference between mean arterial blood pressure and mean intracranial pressure, being commonly applied in neurocritical care. This commentary discusses recent physiological advances in knowledge as well as bedside practice issues that in combination indicate considering CPP under this perspective may lead to inaccurate assumptions and potentially misleading decision making.

摘要

脑灌注压（CPP）的计算方法为平均动脉压与颅内压之差，常用于神经危重症患者的临床管理。本评论探讨了近期在生理学知识方面的进展以及床边实际操作问题，综合来看，这些问题表明，从这一角度考虑 CPP 可能会导致不准确的假设和潜在的误导性决策。

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Point-Counterpoint: Cerebral perfusion pressure is a high-risk concept.观点对撞：脑灌注压是一个高危概念。
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Dynamic Cerebrovascular and Intracranial Pressure Reactivity Assessment of Impaired Cerebrovascular Autoregulation in Intracranial Hypertension.颅内高压时脑血管自动调节受损的动态脑血管及颅内压反应性评估
Acta Neurochir Suppl. 2016;122:255-60. doi: 10.1007/978-3-319-22533-3_51.
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Visualisation of the 'Optimal Cerebral Perfusion' Landscape in Severe Traumatic Brain Injury Patients.重度创伤性脑损伤患者“最佳脑灌注”情况的可视化
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Critical cerebral perfusion pressure at high intracranial pressure measured by induced cerebrovascular and intracranial pressure reactivity.通过诱导脑血管和颅内压反应性测量高颅内压时的临界脑灌注压。
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Impact of cerebral perfusion pressure and autoregulation on intracranial dynamics: a modeling study.脑灌注压和自动调节对颅内动力学的影响：一项建模研究。
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A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts.神经危重症中颅内压监测与个体化管理的全面视角：全球专家调查结果。
Neurocrit Care. 2024 Dec;41(3):880-892. doi: 10.1007/s12028-024-02008-z. Epub 2024 May 29.

本文引用的文献

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Point/counterpoint: Cerebrovascular resistance is a flawed concept.观点对垒：脑血管阻力是一个有缺陷的概念。
J Cereb Blood Flow Metab. 2023 Jul;43(7):1216-1218. doi: 10.1177/0271678X231172854. Epub 2023 Apr 27.
2
The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management.颅内分区综合征：急性脑损伤监测和管理的一种模型。
Crit Care. 2023 Apr 10;27(1):137. doi: 10.1186/s13054-023-04427-4.
3
Critical Closing Pressure and Cerebrovascular Resistance Responses to Intracranial Pressure Variations in Neurocritical Patients.神经危重症患者颅内压变化时的临界关闭压力和脑血管阻力反应。
Neurocrit Care. 2023 Oct;39(2):399-410. doi: 10.1007/s12028-023-01691-8. Epub 2023 Mar 3.
4
Contribution of intracranial pressure to human dynamic cerebral autoregulation after acute brain injury.颅内压对急性脑损伤后人体动态脑自动调节的作用。
Am J Physiol Regul Integr Comp Physiol. 2023 Feb 1;324(2):R216-R226. doi: 10.1152/ajpregu.00252.2022. Epub 2022 Dec 26.
5
A systematic observation of vasodynamics from different segments along the cerebral vasculature in the penumbra zone of awake mice following cerebral ischemia and recanalization.清醒状态下脑缺血再灌注后小鼠半影区脑血循环不同节段血管动力学的系统观察。
J Cereb Blood Flow Metab. 2023 May;43(5):665-679. doi: 10.1177/0271678X221146128. Epub 2022 Dec 16.
6
Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation.人脑血流的调节：自身调节的生理学和临床意义。
Physiol Rev. 2021 Oct 1;101(4):1487-1559. doi: 10.1152/physrev.00022.2020. Epub 2021 Mar 26.
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Defining a Taxonomy of Intracranial Hypertension: Is ICP More Than Just a Number?颅内高压分类学定义：颅内压是否不仅仅是一个数字？
J Neurosurg Anesthesiol. 2020 Apr;32(2):120-131. doi: 10.1097/ANA.0000000000000609.
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Blood Pressure Gradients in the Brain: Their Importance to Understanding Pathogenesis of Cerebral Small Vessel Disease.大脑中的血压梯度：它们对理解脑小血管病发病机制的重要性。
Brain Sci. 2019 Jan 23;9(2):21. doi: 10.3390/brainsci9020021.
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HEMODYNAMICS OF COLLAPSIBLE VESSELS WITH TONE: THE VASCULAR WATERFALL.具有张力的可塌陷血管的血流动力学：血管瀑布现象
J Appl Physiol. 1963 Sep;18:924-32. doi: 10.1152/jappl.1963.18.5.924.
10
Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of the cerebral circulation in the absence of intracranial hypertension.在无颅内高压的情况下，脑血管张力而非颅内压决定了脑循环的有效下游压力。
J Neurosurg Anesthesiol. 2000 Jul;12(3):210-6. doi: 10.1097/00008506-200007000-00002.