Cerebral blood flow and the injured brain: how should we monitor and manipulate it?
Cerebral blood flow and the injured brain: how should we monitor and manipulate it?
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DOI：
10.1097/aco.0b013e3283445898
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发表时间：
2011-04-01
影响因子：
2.5
通讯作者：
Lam, Arthur M.
中科院分区：
文献类型：
--
作者：
Dagal, Armagan;Lam, Arthur M.
脑缺血在创伤性脑损伤和蛛网膜下腔出血等脑损伤的病理生理中起着重要作用，因此改善预后可能需要监测和优化脑血流量（CBF）。为了有意义地解释脑血流结果，可能有必要量化脑自动调节和脑代谢。本文综述了创伤性脑损伤中脑血流变化及其监测/管理的最新证据。最近的发现最近关于外伤性脑损伤患者管理的证据集中在大脑自动调节在维持灌注中的重要性，这需要测量CBF。然而，仅仅足够的脑血流测量并不能表明输送到神经元组织的氧气量。测量设备的技术进步已经能够评估脑组织的代谢状态，以指导治疗、进展和预后。当前的神经危重症护理管理策略侧重于预防和限制继发性脑损伤，其中神经损伤在原发性损伤后的数小时和数天内继续发展。适当选择多模式监测，包括CBF和管理措施，可降低死亡率和发病率。
Purpose of reviewCerebral ischemia plays a major role in the pathophysiology of the injured brain, including traumatic brain injury and subarachnoid hemorrhage, thus improvement in outcome may necessitate monitoring and optimization of cerebral blood flow (CBF). To interpret CBF results in a meaningful way, it may be necessary to quantify cerebral autoregulation as well as cerebral metabolism. This review addresses the recent evidence related to the changes in CBF and its monitoring/management in traumatic brain injury.Recent findingsRecent evidence on the management of patients with traumatic brain injury have focused on the importance of cerebral autoregulation in maintaining perfusion, which necessitates the measurement of CBF. However, adequate CBF measurements alone would not indicate the amount of oxygen delivered to neuronal tissues. Technologic advancements in measurement devices have enabled the assessment of the metabolic state of the cerebral tissue for the purpose of guiding therapy, progress as well as prognostification.SummaryCurrent neurocritical care management strategies are focused on the prevention and limitation of secondary brain injury where neuronal insult continues to evolve during the hours and days after the primary injury. Appropriately chosen multimodal monitoring including CBF and management measures can result in reduction in mortality and morbidity.