Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest.
Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest.
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DOI：
10.3389/fped.2017.00174
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发表时间：
2017
影响因子：
2.6
通讯作者：
Manole MD
中科院分区：
文献类型：
--
作者：
Iordanova B;Li L;Clark RSB;Manole MD
超过50%的从心脏骤停中成功复苏的患者有神经功能障碍的证据。在儿童和成人以及动物模型中进行的大量研究表明，心脏骤停后脑血流量（CBF）受损。复苏后脑灌注的阶段包括早期充血，随后是低充血，最后血流量恢复正常或延长充血。在微循环水平，血液流动是不均匀的，有无流量、低流量和流量增加的区域。在心脏骤停动物模型中，CBF定向治疗改善了神经系统预后，因此，心脏骤停后CBF的改变可能有助于缺氧缺血性脑病的发展。目前心脏骤停后的重症监护主要集中在维持全身氧合、正常的年龄血压值、维持体内平衡和避免高热。心脏骤停后不常规评估CBF和氧合。目前可用的和未充分利用的评估脑灌注的技术包括经颅多普勒、近红外光谱和动脉自旋标记磁共振成像。有限的临床研究确定了CBF和氧合监测在心脏骤停后预后中的作用，很少有研究表明，将复苏后重症监护的平均动脉压高于最低自我调节范围可能会改善预后。因此，在心脏骤停复苏后的脑监测、CBF和氧靶定向治疗方面仍然存在重要的知识空白。
Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF) is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.
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影响因子：
6.5
作者：
Ameloot, K.;Genbrugge, C.;DeDeyne, C.
通讯作者：
DeDeyne, C.
影响因子：
8.3
作者：
BECKSTEAD, JE;TWEED, WA;MACKEEN, WL
通讯作者：
MACKEEN, WL
影响因子：
6.5
作者：
Debaty, Guillaume;Shin, Sang Do;Lurie, Keith
通讯作者：
Lurie, Keith
使用ASL-MRI，在大鼠中，进入脑血流与心室纤颤后的脑血流的全球和区域差异。
影响因子：
6.5
作者：
Drabek T;Foley LM;Janata A;Stezoski J;Hitchens TK;Manole MD;Kochanek PM
通讯作者：
Kochanek PM
影响因子：
3.4
作者：
Crouzet, Christian;Wilson, Robert H.;Akbari, Yama
通讯作者：
Akbari, Yama