CEREBRAL BLOOD-FLOW AND METABOLISM IN CHILDREN WITH SEVERE HEAD-INJURY .1. RELATION TO AGE, GLASGOW COMA SCORE, OUTCOME, INTRACRANIAL-PRESSURE, AND TIME AFTER INJURY
CEREBRAL BLOOD-FLOW AND METABOLISM IN CHILDREN WITH SEVERE HEAD-INJURY .1. RELATION TO AGE, GLASGOW COMA SCORE, OUTCOME, INTRACRANIAL-PRESSURE, AND TIME AFTER INJURY
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DOI：
10.1136/jnnp.58.2.145
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发表时间：
1995-02-01
影响因子：
11
通讯作者：
EYRE, JA
中科院分区：
文献类型：
--
作者：
SHARPLES, PM;STUART, AG;EYRE, JA
了解小儿颅脑外伤的病理生理学对合理的急性治疗至关重要。有人提出，儿童对严重头部损伤的反应与成人不同，脑血流量增加（脑充血）是颅内压升高的最常见原因，但这一观点最近受到了争议。在儿童中，病理生理反应与损伤后时间的关系尚未明确。本文描述了对21例严重颅脑损伤儿童进行的151项脑血流、动颈静脉氧差（AJVDo(2)）和脑氧代谢率（CMRo(2)）的连续测量，这些儿童平均年龄8岁（范围2-16），格拉斯哥昏迷评分小于或等于8。绝对脑充血不常见，151例脑血流值中只有10例（7%）达到或高于正常儿童公布的范围上限。脑血流量与颅内压呈负相关。（r= -0.24, p = 0.009）。与人们普遍认为脑损伤患者的脑代谢率总是很低的假设相反，17/21（81%）儿童的CMRo(2)最初在正常范围内。CMRo(2)和AJVDo(2)在损伤后第1天至第3天显著下降。随着时间的推移，脑血含量没有明显上升。这些数据首次证明，在创伤性脑损伤实验模型中报道的脑代谢率的时间变化也发生在脑损伤患者中。随着时间的推移，病理生理上的变化提示治疗可能需要相应的修改。如果重型颅脑损伤患儿脑代谢率和脑氧提取量在损伤后不久达到最大值，则患儿在此期间最容易发生继发性损伤。
Understanding the pathophysiology of paediatric head trauma is essential for rational acute management. It has been proposed that the response to severe head injury in children differs from that in adults, with increased cerebral blood flow (cerebral hyperaemia) representing the most common cause of raised intracranial pressure, but this has recently been disputed. The relation between the pathophysiological response and time after injury has not been defined in children.This paper describes 151 serial measurements of cerebral blood flow, arteriojugular venous oxygen difference (AJVDo(2)), and cerebral metabolic rate for oxygen (CMRo(2)) that were performed in 21 children with severe head injury, mean age 8 (range 2-16) years, Glasgow coma score less than or equal to 8.Absolute cerebral hyperaemia was uncommon, only 10 (7%) of the 151 cerebral blood flow values being at or above the upper Limit of the range published in normal children. There was an inverse correlation between cerebral blood flow and intracranial pressure. (r= -0.24, p = 0.009). Contrary to the widespread assumption that cerebral metabolic rate in patients with head injury is always low, CMRo(2) was initially within the normal range in 17/21 (81%) children. Both CMRo(2) and AJVDo(2) fell significantly between the first and third days after injury. There was a non-significant rise in cerebral blood how over time.These data represent the first evidence that the temporal change in cerebral metabolic rate reported in experimental models of traumatic brain injury also occurs in patients with head injury. The in the pathophysiological over time suggest that the management may need to be modified accordingly. If cerebral metabolic rate and cerebral oxygen extraction are maximal shortly after injury in children with severe head injury then the children are most likely to sustain secondary damage during this period.