Cerebrovascular Pathophysiology in Pediatric Traumatic Brain Injury
Cerebrovascular Pathophysiology in Pediatric Traumatic Brain Injury
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DOI：
10.1097/ta.0b013e3181ad32c7
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发表时间：
2009-08-01
影响因子：
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通讯作者：
Vavilala, Monica S.
中科院分区：
文献类型：
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作者：
Philip, Shaji;Udomphorn, Yuthana;Vavilala, Monica S.
背景：创伤性脑损伤是儿童外伤性发病率和死亡率的主要原因。尽管在成人和实验动物模型中关于脑外伤的信息越来越多，但对儿童特有的脑血管病理生理学知之甚少。材料：回顾相关医学文献。结果：低血压、低氧、高血糖和发热等全身和脑血流动力学因素与儿童脑外伤预后不良有关。同样，脑损伤后的脑自动调节功能通常受损，可能会对预后产生不利影响，特别是在全身血流动力学改变的情况下。此外，儿童脑外伤后二氧化碳血管反应性可能发生改变，导致脑缺血或高血症。结论：需要了解儿童脑损伤对脑循环的影响，以潜在地制定方案来改善这一脆弱人群的预后。具体地说，必须了解儿科脑血管生理学和病理生理学的变化，包括二氧化碳血管反应性和压力自动调节，并阐明其机制。
Background: Traumatic brain injury (TBI) is the leading cause of traumatic morbidity and mortality in children. Although there is increasing information concerning TBI in adults and experimental animal models, relatively little is known regarding cerebrovascular pathophysiology specific to children.Materials: A review of the pertinent medical literature.Results: Systemic and cerebral hemodynamic factors such as hypotension, hypoxia, hyperglycemia, and fever are associated with poor outcome in pediatric TBI. Similarly, cerebral autoregulation is often impaired after TBI and may adversely affect outcome, especially if systemic hemodynamics are altered. Furthermore, CO2 vasoreactivity may be altered after pediatric TBI and lead to either cerebral ischemia or hyperemia.Conclusions: Understanding the effect of pediatric TBI on the cerebral circulation is needed to potentially develop protocols to improve outcome in this vulnerable population. Specifically, changes in pediatric cerebrovascular physiology and pathophysiology, including CO2 vasoreactivity and pressure autoregulation, must be understood and their mechanism elucidated.