Impaired cerebral autoregulation and elevation in plasma glial fibrillary acidic protein level during cardiopulmonary bypass surgery for CHD.
Impaired cerebral autoregulation and elevation in plasma glial fibrillary acidic protein level during cardiopulmonary bypass surgery for CHD.
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DOI：
10.1017/s1047951117001573
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发表时间：
2018-01
影响因子：
1
通讯作者：
Everett AD
中科院分区：
文献类型：
--
作者：
Easley RB;Marino BS;Jennings J;Cassedy AE;Kibler KK;Brady KM;Andropoulos DB;Brunetti M;Hogue CW;Heitmiller ES;Lee JK;Spaeth J;Everett AD
脑血管反应性监测已用于确定成年脑损伤患者压力自动调节的下限。我们假设，心肺转流期间脑血管反应性受损和时间低于自动调节下限将导致大脑低灌注损伤，可通过血清胶质纤维酸性蛋白水平升高来检测。我们设计了一项多中心观察性试点研究，结合体外循环期间并发的脑血管反应性和生物标志物监测。所有因 CHD 接受搭桥手术的儿童均符合资格。使用血红蛋白体积指数监测自动调节，血红蛋白体积指数是平均动脉血压与基于近红外光谱的脑血量趋势之间的移动相关系数。血红蛋白体积指数和神经胶质原纤维酸性蛋白数据均按旁路阶段进行分析。分析每位患者的自动调节曲线，以确定自动调节的下限和最佳动脉血压。共有 57 名儿童获得了搭桥所有阶段的自动调节和生物标志物数据。平均基线血红蛋白体积指数为 0.084。血红蛋白体积指数随着压力的降低而增加，82% 的人表现出自动调节的下限 (41 ± 9 mmHg)，而 100% 的人表现出最佳血压 (48 ± 11 mmHg)。个体的峰值自动调节与生物标志物值之间存在显着关联（p = 0.01）。个体、动态非侵入性脑血管反应性监测显示与可能的无症状脑损伤相关的短暂损伤。自动调节负担受损与血清脑生物标志物升高之间的关联可能会识别可能导致损伤的脑灌注风险。
Cerebrovascular reactivity monitoring has been used to identify the lower limit of pressure autoregulation in adult patients with brain injury. We hypothesise that impaired cerebrovascular reactivity and time spent below the lower limit of autoregulation during cardiopulmonary bypass will result in hypoperfusion injuries to the brain detectable by elevation in serum glial fibrillary acidic protein level. We designed a multicentre observational pilot study combining concurrent cerebrovascular reactivity and biomarker monitoring during cardiopulmonary bypass. All children undergoing bypass for CHD were eligible. Autoregulation was monitored with the haemoglobin volume index, a moving correlation coefficient between the mean arterial blood pressure and the near-infrared spectroscopy-based trend of cerebral blood volume. Both haemoglobin volume index and glial fibrillary acidic protein data were analysed by phases of bypass. Each patient’s auto-regulation curve was analysed to identify the lower limit of autoregulation and optimal arterial blood pressure. A total of 57 children had autoregulation and biomarker data for all phases of bypass. The mean baseline haemoglobin volume index was 0.084. Haemoglobin volume index increased with lowering of pressure with 82% demonstrating a lower limit of autoregulation (41 ± 9 mmHg), whereas 100% demonstrated optimal blood pressure (48 ± 11 mmHg). There was a significant association between an individual’s peak autoregulation and biomarker values (p =0.01). Individual, dynamic non-invasive cerebrovascular reactivity monitoring demonstrated transient periods of impairment related to possible silent brain injury. The association between an impaired autoregulation burden and elevation in the serum brain biomarker may identify brain perfusion risk that could result in injury.