Gomez Jonathan R, Bhende Bhagyashri U, Mathur Rohan, Gonzalez L Fernando, Shah Vishank A
Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, USA; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, USA; Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurotherapeutics. 2025 Jan;22(1):e00526. doi: 10.1016/j.neurot.2025.e00526. Epub 2025 Jan 18.
Cerebral autoregulation (CA) is the physiological process by which cerebral blood flow is maintained during fluctuations in arterial blood pressure (ABP). There are various validated methods to measure CA, either invasively, with intracranial pressure or brain tissue oxygenation monitors, or noninvasively, with transcranial Doppler ultrasound or near-infrared spectroscopy. Utilizing these monitors, researchers have been able to discern CA patterns in several pathological states, such as but not limited to acute ischemic stroke, spontaneous intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, sepsis, and post-cardiac arrest, and they have found CA to be altered in these patients. CA disturbances predispose patients suffering from these ailments to worse outcomes. Much focus has been placed on CA monitoring in these populations, with an emphasis on arterial blood pressure optimization. Many guidelines recommend universal static ABP targets; however, in patients with altered CA, these targets may make them susceptible to hypoperfusion and further neurological injury. Based on this observation, there has been much investigation on individualized ABP goals and their effect on clinical outcomes. The scope of this review includes (1) a summary of the physiology of CA in healthy adults; (2) a review of the evidence on CA monitoring in healthy individuals; (3) a summary of CA changes and its effect on outcomes in various diseased states including acute ischemic stroke, spontaneous intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, sepsis and meningitis, post-cardiac arrest, hypoxic-ischemic encephalopathy, surgery, and moyamoya disease; and (4) a review of the current evidence on individualized ABP changes in various patient populations.
脑自动调节（CA）是一种生理过程，通过该过程在动脉血压（ABP）波动期间维持脑血流量。有多种经过验证的方法来测量CA，既可以通过颅内压或脑组织氧合监测器进行有创测量，也可以通过经颅多普勒超声或近红外光谱进行无创测量。利用这些监测器，研究人员已经能够识别几种病理状态下的CA模式，例如但不限于急性缺血性中风、自发性颅内出血、动脉瘤性蛛网膜下腔出血、败血症和心脏骤停后，并且他们发现这些患者的CA发生了改变。CA紊乱使患有这些疾病的患者更容易出现更差的预后。这些人群的CA监测受到了很多关注，重点是优化动脉血压。许多指南推荐通用的静态ABP目标；然而，在CA改变的患者中，这些目标可能使他们易受灌注不足和进一步神经损伤的影响。基于这一观察结果，人们对个体化ABP目标及其对临床结局的影响进行了大量研究。本综述的范围包括：（1）健康成年人CA生理学的总结；（2）健康个体CA监测证据的综述；（3）各种疾病状态下CA变化及其对结局影响的总结，包括急性缺血性中风、自发性颅内出血、动脉瘤性蛛网膜下腔出血、败血症和脑膜炎、心脏骤停后、缺氧缺血性脑病、手术和烟雾病；以及（4）各种患者群体中个体化ABP变化的当前证据综述。
