Cerebral autoregulation following minor head injury
Cerebral autoregulation following minor head injury
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DOI：
10.3171/jns.1997.86.3.0425
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发表时间：
1997-03-01
影响因子：
4.1
通讯作者：
Winn, HR
中科院分区：
文献类型：
--
作者：
Junger, EC;Newell, DW;Winn, HR
本研究的目的是确定轻度头部损伤患者的大脑自动调节功能是否受损。29例轻度颅脑损伤患者的格拉斯哥昏迷评分（GCS）为13至15分，在损伤后48小时内，使用连续经颅多普勒速度记录和血压记录进行动态脑自动调节测试。29名年龄匹配的正常志愿者以同样的方式进行了自我调节测试，以建立比较值。通过脑血流速度对引起的动脉血压快速短暂变化的反应来评估自调节反应的功能，并以自调节指数（ARI）来测量。29例轻度颅脑损伤患者中有8例（28%）表现出功能不良或缺乏大脑自动调节，而对照组中没有，这种差异非常显著（p = 0.008）。回归分析发现，头部损伤患者血压降低与自身调节能力差有显著相关性（r = 0.6, p < 0.001）；然而，血压降低并不是所有患者自身调节功能受损的原因。在这组头部损伤患者中，ARI与初始GCS或1个月格拉斯哥结果量表评分之间没有相关性。这项研究表明，相当数量的轻度颅脑损伤患者可能存在大脑自身调节功能受损，并可能增加继发性缺血性神经元损伤的风险。
The purpose of this study was to determine whether patients with minor head injury experience impairments in cerebral autoregulation. Twenty-nine patients with minor head injuries defined by Glasgow Coma Scale (GCS) scores of 13 to 15 underwent testing of dynamic cerebral autoregulation within 48 hours of their injury using continuous transcranial Doppler velocity recordings and blood pressure recordings. Twenty-nine age-matched normal volunteers underwent autoregulation testing in the same manner to establish comparison values. The function of the autoregulatory response was assessed by the cerebral blood flow velocity response to induced rapid brief changes in arterial blood pressure and measured as the autoregulation index (ARI).Eight (28%) of the 29 patients with minor head injury demonstrated poorly functioning or absent cerebral autoregulation versus none of the controls, and this difference was highly significant (p = 0.008). A significant correlation between lower blood pressure and worse autoregulation was found by regression analysis in bead-injured patients (r = 0.6, p < 0.001); however, lower blood pressure did not account for the autoregulatory impairment in all patients. Within this group of head-injured patients there was no correlation between ARI and initial GCS or 1-month Glasgow Outcome Scale scores. This study indicates that a significant number of patients with minor head injury may have impaired cerebral autoregulation and may be at increased risk for secondary ischemic neuronal damage.