Cerebral blood flow as a predictor of outcome following traumatic brain injury.
Cerebral blood flow as a predictor of outcome following traumatic brain injury.
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DOI：
10.3171/foc.1997.2.2.2
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发表时间：
1997-02
影响因子：
4.1
通讯作者：
Daniel F. Kelly;Neil A Martin;R. Kordestani;George J. Counelis;D. Hovda;M. Bergsneider;E. Shalmon;D. McBride;Dena Herman;Donald P. Becker
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文献类型：
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作者：
Daniel F. Kelly;Neil A Martin;R. Kordestani;George J. Counelis;D. Hovda;M. Bergsneider;E. Shalmon;D. McBride;Dena Herman;Donald P. Becker
作为头部损伤脑血管效应前瞻性研究的一部分，54名中度和重度损伤患者接受了184项133 Xe-脑血流量（CBF）研究，以确定最大血流量时间与结局之间的关系。在损伤当天（第0天）观察到最低血流量，在损伤后第1至5天记录到最高CBF。根据在最大流量期间获得的CBF值，将患者分为三组：（7名患者），所有测定的CBF均小于33 ml/100 g/min;第2组（13例患者），CBF均小于和大于或等于33 ml/100 g/min;第3组（34例患者），所有测量值的CBF均大于或等于33 ml/100 g/min。对于第1、2和3组，损伤后第1至5天的平均CBF分别为25.7 +/- 4、36.5 +/- 4.2和49.4 +/- 9.3 ml/100 g/min，CBF研究时的PaCO 2分别为31.4 +/- 6、32.7 +/- 2.9和33.4 +/- 4.7 mmHg。分别第1、2和3组之间的平均年龄、年龄小于35岁的个体百分比存在显著差异（分别为42.9%、23.1%和76.5%），需要硬膜内血肿清除的患者发生率（分别为57.1%、38.5%和17.6%）和异常瞳孔发生率（分别为57.1%、61.5%和32.4%）。第1、2和3组在损伤后6个月的良好神经学结局分别为0%、46.2%和58.8%（p 55 ml/100 g/min和ICP > 20 mm Hg）。这6例患者在伤后第1 - 5天的CBF最高（平均59.8 ml/100 g/min），颅内高压程度最严重，脑灌注压降低（p < 0.0001）。这些结果表明，脑外伤后CBF急性阶段性升高是实现功能恢复的必要条件。据推测，对于大多数患者，血流量的增加是由于在血管反应性完整的情况下代谢需求增加所致。然而，在少数个体中，超正常CBF、严重颅内高压和不良结局的组合表明血管反应性严重受损，血流和代谢之间存在解偶联。
As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe-cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 +/- 4, 36.5 +/- 4.2, and 49.4 +/- 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 +/- 6, 32.7 +/- 2.9, and 33.4 +/- 4.7 mm Hg, respectively. There were significant differences across Groups 1, 2, and 3 regarding mean age, percentage of individuals younger than 35 years of age (42.9%, 23.1%, and 76.5%, respectively), incidence of patients requiring evacuation of intradural hematomas (57.1%, 38.5%, and 17.6%, respectively) and incidence of abnormal pupils (57.1%, 61.5%, and 32.4%, respectively). Favorable neurological outcome at 6 months postinjury in Groups 1, 2, and 3 was 0%, 46.2%, and 58.8%, respectively (p 55 ml/100 g/minute and ICP > 20 mm Hg). These six patients were unique in having the highest CBFs for postinjury Days 1 to 5 (mean 59.8 ml/100 g/minute) and the most severe degree of intracranial hypertension and reduced cerebral perfusion pressure (p < 0.0001). These results indicate that a phasic elevation in CBF acutely after head injury is a necessary condition for achieving functional recovery. It is postulated that for the majority of patients, this rise in blood flow results from an increase in metabolic demands in the setting of intact vasoreactivity. In a minority of individuals, however, the constellation of supranormal CBF, severe intracranial hypertension, and poor outcome indicates a state of grossly impaired vasoreactivity with uncoupling between blood flow and metabolism.