Continuous cerebral autoregulation monitoring by cross-correlation analysis.
Continuous cerebral autoregulation monitoring by cross-correlation analysis.
复制标题
通过互相关分析进行连续脑自动调节监测。
作者：
R. Steinmeier;R. P. Hofmann;C. Bauhuf;U. Hübner;R. Fahlbusch
为了验证动脉血压（aBP）和颅内压（ICP）或流速的自发缓慢振荡之间的互相关分析作为连续评估脑自动调节状态的手段，我们将其结果与不同的自动调节床边测试进行了比较。第二个目的是检查该方法在较长时间内的稳定性。对 13 名危重昏迷患者连续测量 aBP、ICP 和大脑中动脉 (FV(MCA)) 流速。对aBP和ICP（CC [aBP --> ICP]）和aBP/FV（MCA）（CC [aBP --> FV(MCA)]）进行在线和离线互相关分析。在 29 分钟互相关测试期之前立即进行了三种不同的自动调节床边测试（袖带放气、短暂充血反应、直立性低血压）。此外，还进行了多个小时的连续互相关自动调节监测（以便分析稳定性并评估其他因素的影响）。聚类分析揭示了两个主要聚类。簇 1（表明自动调节受到干扰）显示 CC [aBP --> ICP] 的质心位于 t = -0.21 +/- 3.32 秒、r = 0.43 +/- 0.18，CC [aBP --> FV(MCA)] 的质心位于 t = 0 +/- 3.14 秒、r = 0.44 +/- 0.18。簇 2（指示正常自动调节）显示 CC [aBP --> ICP] 的质心位于 t = 4.94 +/- 3.74 秒，r =- 0.4 +/- 0.16，CC [aBP --> FV(MCA)] 的 t = 3.38 +/- 4.44 秒，r = -0.38 +/- 0.18。互相关测试结果与床边测试之间的比较显示，CC [aBP --> FV(MCA)] 的敏感性为 44-73%，而 CC [aBP --> ICP] 的特异性更高 (60-80%)。长期监测显示在大约 45% 的测量时间内进行了稳定的互相关测试。结论是，aBP、ICP 和 FV(MCA) 之间的互相关是连续监测自动调节状态的有效手段，但需要进一步提高灵敏度和特异性以使其对临床决策可靠。
In order to validate cross-correlation analysis between spontaneous slow oscillations of arterial blood pressure (aBP) and intracranial pressure (ICP) or flow velocity as a means to assess the status of cerebral autoregulation continuously, we compared its results with different autoregulation bedside tests. The second aim was to check the method's stability over longer time periods. aBP, ICP, and flow velocity in the middle cerebral artery (FV(MCA)) was measured continuously in 13 critically ill comatose patients. Cross-correlation analysis was performed online and offline between aBP and ICP (CC [aBP --> ICP]) and aBP/FV(MCA) (CC [aBP --> FV(MCA)]). Three different autoregulation bedside tests (cuff deflation, transient hyperemic response, orthostatic hypotension) were performed immediately before a 29-min cross-correlation test period. In addition, continuous cross-correlation autoregulation monitoring was performed over multiple hours (in order to analyze for stability and to assess the influence of other factors). Cluster analysis revealed two main clusters. Cluster 1 (indicative for disturbed autoregulation) showed a centroid at t = -0.21 +/- 3.32 sec, r = 0.43 +/- 0.18 for CC [aBP --> ICP], and t = 0 +/- 3.14 sec, r = 0.44 +/- 0.18 for CC [aBP --> FV(MCA)]. Cluster 2 (indicative for normal autoregulation) revealed a centroid at t = 4.94 +/- 3.74 sec, r =- 0.4 +/- 0.16 for CC [aBP --> ICP], and t = 3.38 +/- 4.44 sec, r = -0.38 +/- 0.18 for CC [aBP --> FV(MCA)]. Comparison between the cross-correlation test results and the bedside tests showed a sensitivity of 44-73% for CC [aBP --> FV(MCA)], whereas CC [aBP --> ICP] was more specific (60-80%). Long-term monitoring revealed stable cross-correlation tests in about 45% of the measurement time. It is concluded that cross-correlation between aBP, ICP, and FV(MCA) is a valid means to monitor the autoregulation status continuously, although further improvement of sensitivity and specificity is needed to make it reliable for clinical decision making.
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影响因子：
4.8
作者：
Newell, DW;Weber, JP;Winn, HR
通讯作者：
Winn, HR
影响因子：
4.1
作者：
Junger, EC;Newell, DW;Winn, HR
通讯作者：
Winn, HR
脑挫伤内部和周围的脑血流量和血管反应性。
影响因子：
4.1
作者：
McLaughlin,MR;Marion,DW
通讯作者：
Marion,DW
影响因子：
8.3
作者：
TIECKS, FP;LAM, AM;NEWELL, DW
通讯作者：
NEWELL, DW