重型颅脑损伤后脑血流动力学储备的多模式监测与评价。

M Czosnyka, P J Kirkpatrick, J D Pickard
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摘要

这篇文章包含了一个概述选择的临床技术用于神经重症监护监测和测试的大脑自动调节严重颅脑损伤后的患者。采用多种方式监测脑血流动力学储备,包括颅内压、脑灌注压(CPP)、大脑中动脉血流速度(FV)、颈静脉球氧饱和度、激光多普勒皮质血流法、大脑皮层近红外光谱、组织氧合、微透析等。大量的信息需要专门的计算机支持来合理地解释和过滤工件。综述了基于经颅多普勒超声检测脑自调节储备的方法。在实践中,重复或连续的评估是重要的,因为自动调节储备可能随时间波动。静态和动态的自我调节速率显示出对二氧化碳诱导的血管舒张的敏感性,但与头部损伤后的结果没有相关性。颈动脉压迫试验,用于评估蛛网膜下腔出血后的患者,尚未证明其在头部损伤中的有效性。MCA FV和CPP的连续波形分析与复苏后的昏迷评分和结果相关,因此可以被认为是评估通气头部创伤患者自我调节的可靠方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multimodal monitoring and assessment of cerebral haemodynamic reserve after severe head injury.

This article contains an overview of selected clinical techniques employed for neurointensive care monitoring and testing of cerebral autoregulation of patients following severe head injury. Multiple modalities are used for monitoring of cerebral haemodynamic reserve, including intracranial pressure, cerebral perfusion pressure (CPP), blood flow velocity (FV) in the middle cerebral artery (MCA), jugular bulb oxygen saturation, laser-Doppler cortical flowmetry, near infrared spectroscopy of cerebral cortex, tissue oxygenation, and microdialysis. Large volumes of information demand specialised computer support for sensible interpretation and filtration of artifacts. Methods of testing of cerebral autoregulatory reserve based on transcranial Doppler ultrasonography are reviewed. Repetitive or continuous assessment is important in practice as autoregulatory reserve may fluctuate in time. Static and dynamic rates of autoregulation show sensitivity to carbon dioxide-induced vasodilatation, but fail to correlate with outcome following head injury. The carotid artery compression test, useful for assessment of patients after subarachnoid haemorrhage, has yet to prove its usefulness in head injury. Continuous waveform analysis of MCA FV and CPP correlates with coma score after resuscitation and outcome and hence may be considered as a robust method for the assessment of autoregulation in ventilated head trauma patients.

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