Castillo-Pinto Carlos, Yu Priscilla, Wainwright Mark S, Kirschen Matthew P
Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
Pediatr Neurol. 2025 Jun;167:9-16. doi: 10.1016/j.pediatrneurol.2025.03.003. Epub 2025 Mar 13.
Managing acute brain injury involves protecting the brain from secondary injury by addressing the mismatch between metabolic demand and cerebral perfusion. Observational studies have associated impaired cerebral autoregulation, a physiological process governing the regulation of cerebral blood flow, with unfavorable neurological outcomes in both pediatric and adult populations. We review the pathophysiology of cerebral autoregulation and discuss methods for assessing and monitoring it in children after acquired brain injury. We also examine the current research investigating the relationship between impaired cerebral autoregulation and outcomes following traumatic brain injury, cardiac arrest, cardiopulmonary bypass, and extracorporeal membrane oxygenation. Furthermore, we outline potential areas for future research in cerebral autoregulation and its clinical implications for pediatric patients with brain injuries.
急性脑损伤的管理包括通过解决代谢需求与脑灌注之间的不匹配来保护大脑免受继发性损伤。观察性研究表明，脑自动调节功能受损（一种控制脑血流量调节的生理过程）与儿童和成人人群中不良的神经学预后相关。我们回顾了脑自动调节的病理生理学，并讨论了在获得性脑损伤后儿童中评估和监测它的方法。我们还研究了当前关于脑自动调节受损与创伤性脑损伤、心脏骤停、体外循环和体外膜肺氧合后预后之间关系的研究。此外，我们概述了脑自动调节未来研究的潜在领域及其对脑损伤儿科患者的临床意义。
