Meng Lingzhong, Sun Yanhua, Rasmussen Mads, Libiran Nicole Bianca S, Naiken Semanti, Meacham Kylie S, Schmidt Jacob D, Lahiri Niloy K, Han Jiange, Liu Ziyue, Adams David C, Gelb Adrian W
From the *Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Anesth Analg. 2024 Nov 4. doi: 10.1213/ANE.0000000000007280.
Niels Lassen's seminal 1959 cerebral autoregulation plot, a cornerstone in understanding the relationship between mean arterial pressure (MAP) and cerebral blood flow (CBF), was based on preexisting literature. However, this work has faced criticism for selective data presentation, leading to inaccurate interpretation. This review revisits and validates Lassen's original plot using contemporary data published since 2000. Additionally, we aim to understand the impact of vasoactive drug treatments on CBF, as Lassen's referenced studies used various drugs for blood pressure manipulation. Our findings confirm Lassen's concept of a plateau where CBF remains relatively stable across a specific MAP range in awake humans with normal brains. However, significant variations in cerebral autoregulation among different populations are evident. In critically ill patients and those with traumatic brain injury, the autoregulatory plateau dissipates, necessitating tight blood pressure control to avoid inadequate or excessive cerebral perfusion. A plateau is observed in patients anesthetized with intravenous agents but not with volatile agents. Vasopressor treatments have population-dependent effects, with contemporary data showing increased CBF in critically ill patients but not in awake humans with normal brains. Vasopressor treatment results in a greater increase in CBF during volatile than intravenous anesthesia. Modern antihypertensives do not significantly impact CBF based on contemporary data, exerting a smaller impact on CBF compared to historical data. These insights underscore the importance of individualized blood pressure management guided by modern data in the context of cerebral autoregulation across varied patient populations.
尼尔斯·拉森1959年具有开创性的脑自动调节曲线图是理解平均动脉压（MAP）与脑血流量（CBF）之间关系的基石，该图基于已有文献。然而，这项工作因选择性的数据呈现而受到批评，导致解读不准确。本综述使用2000年以来发表的当代数据重新审视并验证了拉森的原始曲线图。此外，我们旨在了解血管活性药物治疗对CBF的影响，因为拉森引用的研究使用了各种药物来控制血压。我们的研究结果证实了拉森的概念，即在大脑正常的清醒人类中，在特定的MAP范围内，CBF保持相对稳定的平台期。然而，不同人群之间脑自动调节存在显著差异。在重症患者和创伤性脑损伤患者中，自动调节平台期消失，需要严格控制血压以避免脑灌注不足或过度。在接受静脉麻醉药物的患者中观察到有平台期，但接受挥发性麻醉药物的患者中则没有。血管升压药治疗的效果因人群而异，当代数据显示重症患者的CBF增加，但大脑正常的清醒人类中则没有。与静脉麻醉相比，血管升压药治疗在挥发性麻醉期间导致CBF增加幅度更大。根据当代数据，现代抗高血压药物对CBF没有显著影响，与历史数据相比，对CBF的影响较小。这些见解强调了在不同患者群体的脑自动调节背景下，以现代数据为指导进行个性化血压管理的重要性。
