Department of Neurosurgery, 12288 University of New Mexico School of Medicine , MSC10 5615, 1 UNM, Albuquerque, NM, 87131, USA.
Department of Neurosciences, 12288 University of New Mexico School of Medicine , 915 Camino de Salud NE, Albuquerque, NM, 87106, USA.
Rev Neurosci. 2024 Apr 8;35(6):651-678. doi: 10.1515/revneuro-2024-0028. Print 2024 Aug 27.
Cerebral autoregulation is an intrinsic myogenic response of cerebral vasculature that allows for preservation of stable cerebral blood flow levels in response to changing systemic blood pressure. It is effective across a broad range of blood pressure levels through precapillary vasoconstriction and dilation. Autoregulation is difficult to directly measure and methods to indirectly ascertain cerebral autoregulation status inherently require certain assumptions. Patients with impaired cerebral autoregulation may be at risk of brain ischemia. One of the central mechanisms of ischemia in patients with metabolically compromised states is likely the triggering of spreading depolarization (SD) events and ultimately, terminal (or anoxic) depolarization. Cerebral autoregulation and SD are therefore linked when considering the risk of ischemia. In this scoping review, we will discuss the range of methods to measure cerebral autoregulation, their theoretical strengths and weaknesses, and the available clinical evidence to support their utility. We will then discuss the emerging link between impaired cerebral autoregulation and the occurrence of SD events. Such an approach offers the opportunity to better understand an individual patient's physiology and provide targeted treatments.
脑自动调节是脑血管的一种内在肌源性反应，可在全身血压变化时保持稳定的脑血流水平。通过小动脉收缩和扩张，脑自动调节在广泛的血压范围内都有效。脑自动调节很难直接测量，而间接确定脑自动调节状态的方法本质上需要某些假设。脑自动调节受损的患者可能有脑缺血的风险。代谢受损状态患者发生缺血的中心机制之一可能是触发扩散性去极化 (SD) 事件，最终导致终末 (或缺氧) 去极化。因此，在考虑缺血风险时，脑自动调节和 SD 是相关的。在本次范围综述中，我们将讨论测量脑自动调节的各种方法、它们的理论优缺点，以及支持其效用的现有临床证据。然后，我们将讨论脑自动调节受损与 SD 事件发生之间新出现的联系。这种方法提供了更好地了解个体患者生理学并提供针对性治疗的机会。
