失血性休克对颅内压升高猪模型脑灌注的影响。

The influence of hemorrhagic shock on brain perfusion in a swine model of raised intracranial pressure.

作者信息

Abdou Hossam, Treffalls Rebecca, Jodlowski Grzegorz, Elansary Noha, Ptak Thomas, Walker Patrick F, Morrison Jonathan J

机构信息

R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA.

Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.

出版信息

Eur J Trauma Emerg Surg. 2025 Mar 18;51(1):137. doi: 10.1007/s00068-025-02819-5.

DOI:10.1007/s00068-025-02819-5

PMID:40102249

Abstract

PURPOSE

In patients with hemorrhagic shock and an intracranial space occupying lesion (SOL), brain perfusion is severely compromised due to raised intracranial pressure (rICP), significantly worsening outcomes. This study aims to develop a swine model of a SOL with rICP and shock and characterize the effect on brain perfusion.

METHODS

Ten male swine were divided into two groups- normal ICP (nICP) and rICP. rICP animals had an intracranial Fogarty balloon catheter inserted, which was infused with saline to simulate a SOL. Animals underwent hemorrhage to systolic blood pressures (SBP) of 60, 40, and 20mmHg. Cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured using CT perfusion.

RESULTS

The CBF/Mean arterial pressure (MAP) and CBV/MAP curves were modeled using non-linear regression, with both groups demonstrating a sigmoid relation. In both the CBF/MAP and CBV/MAP curves, animals with rICP had loss of autoregulation at a higher MAP compared to nICP. The curves were an excellent fit for CBF (nICP R = 0.95; rICP R = 0.77) and CBV (nICP R = 0.96; rICP R = 0.78).

CONCLUSIONS

This study aids in quantifying the compounding insult of raised ICP and hemorrhage with regard to brain perfusion. Raised ICP results in autoregulatory failure at a higher MAP compared to animals with nICP. These results can help inform future studies that should be aimed at evaluating novel interventions for this complex clinical scenario.

摘要

目的

在出血性休克合并颅内占位性病变（SOL）的患者中，由于颅内压升高（rICP），脑灌注严重受损，导致预后显著恶化。本研究旨在建立一种伴有rICP和休克的SOL猪模型，并描述其对脑灌注的影响。

方法

将10只雄性猪分为两组——正常颅内压（nICP）组和rICP组。rICP组动物插入颅内Fogarty球囊导管，向其中注入生理盐水以模拟SOL。动物经历出血，使收缩压（SBP）降至60、40和20mmHg。使用CT灌注测量脑血流量（CBF）和脑血容量（CBV）。

结果

使用非线性回归对CBF/平均动脉压（MAP）和CBV/MAP曲线进行建模，两组均呈现S形关系。在CBF/MAP和CBV/MAP曲线中，与nICP组相比，rICP组动物在更高的MAP时出现自动调节功能丧失。这些曲线对CBF（nICP组R = 0.95；rICP组R = 0.77）和CBV（nICP组R = 0.96；rICP组R = 0.78）拟合良好。