Continuous monitoring of regional cerebral blood flow:: experimental and clinical validation of a novel thermal diffusion microprobe
Continuous monitoring of regional cerebral blood flow:: experimental and clinical validation of a novel thermal diffusion microprobe
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DOI：
10.3171/jns.2000.93.2.0265
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发表时间：
2000-08-01
影响因子：
4.1
通讯作者：
Schmiedek, P
中科院分区：
文献类型：
--
作者：
Vajkoczy, P;Roth, H;Schmiedek, P
对象。目前的临床神经监测技术缺乏足够的脑灌注监测。本文介绍了一种新型热扩散探针（TD）用于连续定量评价脑实质内区域脑血流（rCBF）的方法。为了表征这项新技术的时间分辨率，在羊模型CBF标准化变化期间，使用TD微探针（TD-rCBF）测量的rCBF与激光多普勒（LD）血流法测量的rCBF水平进行了比较。为了验证绝对值，将微探针植入16名脑损伤患者的皮质下（硬脑膜以下20 mm），并将TD-rCBF与稳定氙增强计算机断层扫描（sXe-rCBF）同时测量的rCBF进行比较。采用线性回归分析以及Bland和Altman方法对两种方法进行比较。在所有3至5小时的绵羊实验中，可以获得稳定的TD-rCBF测量值。在高碳酸血症期间，TD-rCBF从49.3 +/- 15.8 m1/ 100g /min（平均+/-标准差）增加到119.6 +/- 47.3 ml/ 100g /min，而低碳酸血症使TD-rCBF从51.2 +/- 12.8 ml/ 100g /min下降到39.3 +/- 5.6 ml/ 100g /min。平均动脉血压的变化显示出完整的自动调节，血压极限约为65 mm Hg和170 mm Hg。心脏骤停后，TD-rCBF迅速下降至0 m1/100 g/min。TD-rCBF变化的动态与LD读数的动态很好地对应。比较TD-rCBF和ske - rcbf发现两者具有良好的相关性（r= 0.89; p < 0.0001），两种技术之间的平均差异为1.1 +/- 5.2 ml/100 g/min。新型TD微探针可灵敏、连续、实时地评估脑实质内rCBF的绝对流量值，与sXe-rCBF测量值非常吻合。本研究为将TD-rCBF整合到继发性脑损伤风险患者的多模式监测中提供了基础。
Object. Current clinical neuromonitoring techniques lack adequate surveillance of cerebral perfusion. In this article, a novel thermal diffusion (TD) microprobe is evaluated for the continuous and quantitative assessment of intraparenchymal regional cerebral blood flow (rCBF).Methods. To characterize the temporal resolution of this new technique, rCBF measured using the TD microprobe (TD-rCBF) was compared with rCBF levels measured by laser Doppler (LD) flowmetry during standardized variations of CBF in a sheep model. For validation of absolute values, the microprobe was implanted subcortically (20 mm below the level of dura) into 16 brain-injured patients, and TD-rCBF was compared with simultaneous rCBF measurements obtained using stable xenon-enhanced computerized tomography scanning (sXe-rCBF). The two techniques were compared using linear regression analysis as well as the Bland and Altman method.Stable TD-rCBF measurements could be obtained throughout all 3- to 5-hour sheep experiments. During hypercapnia, TD-rCBF increased from 49.3 +/- 15.8 m1/100 g/min (mean +/- standard deviation) to 119.6 +/- 47.3 ml/100 g/min, whereas hypocapnia produced a decline in TD-rCBF from 51.2 +/- 12.8 ml/100 g/min to 39.3 +/- 5.6 ml/100 g/min. Variations in mean arterial blood pressure revealed an intact autoregulation with pressure limits of approximately 65 mm Hg and approximately 170 mm Hg. After cardiac arrest TD-rCBF declined rapidly to 0 m1/100 g/min. The dynamics of changes in TD-rCBF corresponded well to the dynamics of the LD readings. A comparison of TD-rCBF and sXe-rCBF revealed a good correlation (r= 0.89; p < 0.0001) and a mean difference of 1.1 +/- 5.2 ml/100 g/min between the two techniques.Conclusions. The novel TD microprobe provides a sensitive, continuous, and real-time assessment of intraparenchymal rCBF in absolute flow values that are in good agreement with sXe-rCBF measurements. This study provides the basis for the integration of TD-rCBF into multimodal monitoring of patients who are at risk for secondary brain injury.