Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults.
Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults.
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DOI：
10.1007/s12028-013-9849-7
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发表时间：
2014-06
影响因子：
3.5
通讯作者：
Detre JA
中科院分区：
文献类型：
--
作者：
Kim MN;Edlow BL;Durduran T;Frangos S;Mesquita RC;Levine JM;Greenberg JH;Yodh AG;Detre JA
在神经重症监护病房中，床头操作通常用于优化脑血流量（CBF），但其对CBF的影响很少被测量。这项试点研究采用了一种新型的非侵入性仪器，结合两种技术，用于测量CBF的扩散相关光谱（DCS）和用于测量脑氧合和脱氧血红蛋白浓度的近红外光谱（NIRS），以监测患者在床头降低。10例脑损伤患者和10例正常对照者，采用DCS和NIRS连续监测，头位先30°后0°。在每个位置监测相对CBF（rCBF）和左/右额叶皮质氧合（Δ HbO 2）、脱氧（ΔHb）和总血红蛋白浓度（ΔTHC）的同时变化5分钟。评估患者和对照组反应差异。颅脑损伤患者与健康对照者的rCBF、Δ HbO 2和ΔTHC对低头的反应差异有统计学意义（P<0.02）。患者的rCBF变化不均匀，组平均值未观察到净变化（0.3% ± 28.2%，P=0.938）。对照组rCBF增加（18.6% ± 9.4%，P<0.001）。两组患者的Δ HbO 2、ΔHb和ΔTHC均随低头而增加，但脑损伤患者的增加程度更大。rCBF与脑灌注压的变化呈中度相关（R=0.40，P<0.001），但与颅内压无关。DCS/NIRS检测脑损伤患者与对照组在床头操作过程中CBF和氧合反应的差异。该初步研究支持DCS/NIRS连续床旁测量脑血管血流动力学的可行性，并为更大队列的进一步研究提供了依据。
Head-of-bed manipulation is commonly performed in the neurocritical care unit to optimize cerebral blood flow (CBF), but its effects on CBF are rarely measured. This pilot study employs a novel, non-invasive instrument combining two techniques, diffuse correlation spectroscopy (DCS) for measurement of CBF and near-infrared spectroscopy (NIRS) for measurement of cerebral oxy- and deoxy-hemoglobin concentrations, to monitor patients during head-of-bed lowering. Ten brain-injured patients and ten control subjects were monitored continuously with DCS and NIRS while the head-of-bed was positioned first at 30° and then at 0°. Relative CBF (rCBF) and concurrent changes in oxy- (ΔHbO2), deoxy- (ΔHb), and total-hemoglobin concentrations (ΔTHC) from left/right frontal cortices were monitored for 5 minutes at each position. Patient and control response differences were assessed. rCBF, ΔHbO2, and ΔTHC responses to head lowering differed significantly between brain-injured patients and healthy controls (P<0.02). For patients, rCBF changes were heterogeneous, with no net change observed in the group average (0.3% ± 28.2%, P=0.938). rCBF increased in controls (18.6% ± 9.4%, P<0.001). ΔHbO2, ΔHb, and ΔTHC increased with head lowering in both groups, but to a larger degree in brain-injured patients. rCBF correlated moderately with changes in cerebral perfusion pressure (R=0.40, P<0.001), but not intracranial pressure. DCS/NIRS detected differences in CBF and oxygenation responses of brain-injured patients versus controls during head-of-bed manipulation. This pilot study supports the feasibility of continuous bedside measurement of cerebrovascular hemodynamics with DCS/NIRS and provides the rationale for further investigation in larger cohorts.