Department of Neurosurgery and Neuropathology, National Centre for Neurosurgery, Astana, Republic of Kazakhstan.
Department of Neurorehabilitation, National Centre for Neurosurgery, Astana, Republic of Kazakhstan.
Neurosurg Rev. 2023 Oct 6;46(1):263. doi: 10.1007/s10143-023-02173-3.
Severe traumatic brain injury (TBI) disrupts cerebral autoregulation (CAR), which may increase the risk of secondary neuronal damage in victims with large fluctuations in blood pressure (BP). CAR is also impaired in mild TBI. Given that mild TBI accounts for up to 70% of cases, this issue needs to be addressed. Physiological and non-invasive methods are now required to study CAR without the sharp fluctuations in blood pressure that underlie CAR tests. The cross-spectral analysis of fluctuations between cerebral blood flow and blood pressure discussed in the article is truly non-invasive and physiological. Forty-eight victims with mild traumatic brain injury were studied. CAR was assessed using two methods. The cuff test was used as a control method to assess autoregulation (RoR). Non-invasive cross-spectral analysis with phase shift (PS) detection was performed. The RoR values were normal, but there were cases within the group with varying severity of symptoms of the acute period of mild TBI. For example, the RoR was significantly higher (p < 0.001) in 32 patients with regression of symptoms than in 16 with persistence of symptoms. Their RoR and PS indicated a violation of the CAR, which required correction of the treatment. It was found that in 1/3 of the patients with mild TBI, a different state of CAR required individual tactics. RoR and PS correlated well.
严重创伤性脑损伤 (TBI) 会破坏脑自动调节 (CAR)，这可能会增加血压 (BP) 大幅波动患者继发性神经元损伤的风险。轻度 TBI 也会损害 CAR。鉴于轻度 TBI 占比高达 70%，这个问题需要解决。目前需要使用生理且非侵入性的方法来研究 CAR，而无需进行 CAR 测试所依赖的血压急剧波动。文章中讨论的脑血流和血压之间波动的互谱分析确实是非侵入性和生理性的。研究了 48 名轻度创伤性脑损伤患者。使用两种方法评估 CAR。袖带测试用作评估自动调节 (RoR) 的对照方法。进行了具有相位差 (PS) 检测的非侵入性互谱分析。RoR 值正常，但在轻度 TBI 急性期症状严重程度不同的组内有病例。例如，与症状持续的 16 名患者相比，症状消退的 32 名患者的 RoR 显著更高 (p < 0.001)。他们的 RoR 和 PS 表明 CAR 受到了侵犯，这需要对治疗进行纠正。研究发现，在 1/3 的轻度 TBI 患者中，CAR 的不同状态需要个体化的治疗策略。RoR 和 PS 相关性良好。
