Early cerebral perfusion pressure augmentation with phenylephrine after traumatic brain injury may be neuroprotective in a pediatric swine model.
Early cerebral perfusion pressure augmentation with phenylephrine after traumatic brain injury may be neuroprotective in a pediatric swine model.
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DOI：
10.1097/ccm.0b013e31825333e6
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发表时间：
2012-08
影响因子：
8.8
通讯作者：
Margulies SS
中科院分区：
文献类型：
--
作者：
Friess SH;Smith C;Kilbaugh TJ;Frangos SG;Ralston J;Helfaer MA;Margulies SS
儿童创伤性脑损伤(TBI)后脑灌注压(CPP)低于40 mm Hg与死亡率的增加独立于年龄相关，当前指南建议将CPP维持在40-60 mm Hg之间。尽管成人脑损伤研究已经观察到靶向CPP>；70的并发症风险增加，但我们假设，在未成熟的脑损伤后早期使用苯肾上腺素，靶向CPP为70毫米汞柱将具有神经保护作用。动物随机分为CPP=70 mm Hg(CPP70)和CPP=40 mm Hg(CPP40)两组。弥漫性颅脑损伤是由头部在轴面上一次快速旋转造成的。伤后30min~6h测定脑微透析、脑组织氧分压、颅内压和脑血流量。伤后1小时，用缩血管药苯肾上腺素操作CPP。伤后6h处死动物，固定脑组织，染色观察细胞损伤和轴突功能障碍。大学中心。21头四周龄母猪。CPP增加到70 mm Hg时，轴突功能障碍没有改变，但在损伤后6小时，细胞损伤体积明显小于CPP40(1.1%vs.7.4%，p<；0.05)。与CPP40相比，CPP70的微透析乳酸/丙酮酸比率有所改善。CPP70组CBF较高，但无统计学意义。苯肾上腺素耐受性良好，两组均未观察到血清乳酸或颅内压升高。在未成熟的猪模型中，与CPP为40 mm Hg的模型相比，CPP为70 mm Hg的目标可以更大程度地减少代谢危机和细胞损伤体积。在儿童颅脑损伤严重颅内压升高之前，早期积极增加CPP至70 mm HgCPP可能具有神经保护作用，需要进一步研究。
Cerebral perfusion pressure (CPP) less than 40 mm Hg following pediatric traumatic brain injury (TBI) has been associated with increased mortality independent of age, and current guidelines recommend maintaining CPP between 40–60 mm Hg. Although adult TBI studies have observed an increased risk of complications associated with targeting a CPP > 70, we hypothesize that targeting a CPP of 70 mm Hg with the use of phenylephrine early after injury in the immature brain will be neuroprotective. Animals were randomly assigned to injury with CPP = 70 mm Hg (CPP70) or CPP = 40 mm Hg (CPP40). Diffuse TBI was produced by a single rapid rotation of the head in the axial plane. Cerebral microdialysis, brain tissue oxygen, intracranial pressure, and cerebral blood flow (CBF) were measured 30 min – 6 h post-injury. One hour after injury, CPP was manipulated with the vasoconstrictor phenylephrine. Animals were euthanized 6 h post-TBI, brains fixed, and stained to assess regions of cell injury and axonal dysfunction. University center. 21 four week-old female swine. Augmentation of CPP to 70 mm Hg resulted in no change in axonal dysfunction, but significantly smaller cell injury volumes at 6 hours post injury compared to CPP40 (1.1% vs. 7.4%, p < 0.05). Microdialysis lactate/pyruvate ratios were improved at CPP70 compared to CPP40. CBF was higher in the CPP70 group but did not reach statistical significance. Phenylephrine was well tolerated and there were no observed increases in serum lactate or intracranial pressure in either group. Targeting a CPP of 70 mm Hg resulted in a greater reduction in metabolic crisis and cell injury volumes compared to a CPP of 40 mm Hg in an immature swine model. Early aggressive CPP augmentation to a CPP of 70 mm Hg in pediatric TBI before severe intracranial hypertension has the potential to be neuroprotective, and further investigations are needed.