Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden.
Acta Neurochir (Wien). 2024 Feb 2;166(1):62. doi: 10.1007/s00701-024-05956-9.
Cerebral perfusion pressure (CPP) guidance by cerebral pressure autoregulation (CPA) status according to PRx (correlation mean arterial blood pressure (MAP) and intracranial pressure (ICP)) and optimal CPP (CPPopt = CPP with lowest PRx) is promising but little is known regarding this approach in elderly. The aim was to analyze PRx and CPPopt in elderly TBI patients.
A total of 129 old (≥ 65 years) and 342 young (16-64 years) patients were studied using monitoring data for MAP and ICP. CPP, PRx, CPPopt, and ΔCPPopt (difference between actual CPP and CPPopt) were calculated. Logistic regression analyses with PRx and ΔCPPopt as explanatory variables for outcome. The combined effects of PRx/CPP and PRx/ΔCPPopt on outcome were visualized as heatmaps.
The elderly had higher PRx (worse CPA), higher CPPopt, and different temporal patterns. High PRx influenced outcome negatively in the elderly but less so than in younger patients. CPP close to CPPopt correlated to favorable outcome in younger, in contrast to elderly patients. Heatmap interaction analysis of PRx/ΔCPPopt in the elderly showed that the region for favorable outcome was centered around PRx 0 and ranging between both functioning and impaired CPA (PRx range - 0.5-0.5), and the center of ΔCPPopt was - 10 (range - 20-0), while in younger the center of PRx was around - 0.5 and ΔCPPopt closer to zero.
The elderly exhibit higher PRx and CPPopt. High PRx influences outcome negatively in the elderly but less than in younger patients. The elderly do not show better outcome when CPP is close to CPPopt in contrast to younger patients.
根据 PRx（相关平均动脉血压（MAP）和颅内压（ICP））和最佳 CPP（CPPopt=CPP 与最低 PRx），通过脑压力自动调节（CPA）状态对脑灌注压（CPP）进行指导在老年人中具有很大的应用前景，但目前对此方法知之甚少。本研究旨在分析老年 TBI 患者的 PRx 和 CPPopt。
共对 129 例老年（≥65 岁）和 342 例年轻（16-64 岁）患者使用 MAP 和 ICP 监测数据进行研究。计算 CPP、PRx、CPPopt 和 ΔCPPopt（实际 CPP 和 CPPopt 之间的差异）。采用逻辑回归分析，将 PRx 和 ΔCPPopt 作为预后的解释变量。PRx/CPP 和 PRx/ΔCPPopt 对预后的综合影响以热图的形式呈现。
老年人的 PRx 更高（CPA 更差），CPPopt 更高，且时间模式不同。高 PRx 对老年人的预后有负面影响，但不如对年轻患者的影响大。年轻患者 CPP 接近 CPPopt 与良好预后相关，而老年患者则相反。老年患者 PRx/ΔCPPopt 的热图交互分析显示，有利预后的区域集中在 PRx 为 0 且位于功能和受损的 CPA 之间（PRx 范围为-0.5-0.5），而 ΔCPPopt 的中心为-10（范围为-20-0），而年轻患者的 PRx 中心在-0.5 左右，ΔCPPopt 更接近 0。
老年人表现出更高的 PRx 和 CPPopt。高 PRx 对老年人的预后有负面影响，但不如对年轻患者的影响大。与年轻患者相比，CPP 接近 CPPopt 时，老年患者的预后并未改善。
