Measurement of Cerebral Blood Flow Autoregulation with Rheoencephalography: A Comparative Pig Study.
Measurement of Cerebral Blood Flow Autoregulation with Rheoencephalography: A Comparative Pig Study.
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DOI：
10.2478/joeb-2018-0017
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发表时间：
2018-01-01
影响因子：
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通讯作者：
Armonda, Rocco
中科院分区：
文献类型：
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作者：
Bodo, Michael;D Montgomery, Leslie;Armonda, Rocco
通过检测头部损伤、中风或神经外科手术后的低脑血流量，进行神经监测以防止进一步的(二次)脑损伤。这项比较神经监测研究是正在进行的脑生物阻抗(脑血流图-REG)研究的一部分，作为一种测量方式，用于民用和军用医疗环境，如病人运送、紧急护理和神经外科重症监护。在之前的一项动物研究中，我们验证了REG检测脑血流自动调节(CBF AR)，这是身体的生理机制，可以保护大脑免受低脑血流(缺氧/缺血)的不利影响。在目前的描述性猪研究中，主要目标是将REG对CBF AR的测量与其他神经监测手段的测量进行比较：激光多普勒血流(LDF)、颅内压(ICP)、绝对CBF、颈动脉流量(CF)和全身动脉压(SAP)。对麻醉猪的挑战是严重的诱导出血(出血)和复苏；二氧化碳吸入；呼气末正压(PEEP)。数据被存储在一台计算机上，并离线处理。出血后，REG、ICP和CF检测到CBF AR的丢失，所有这些都被动地跟随着出血后的全身动脉SAP。CBF AR的丢失是低脑血流量的最早指标：CBF AR的丢失发生在心输出量减少之前，心输出量减少是对出血的心血管反应。这项研究的第二个目标是验证为检测CBF AR状态而开发的新的自动数据处理软件的有用性。新的自动化软件和传统的(观察性)评估都表明了CBF AR的状态。REG提示CBF AR最早分解；停止脑电2秒和呼吸可作为CBF AR丧失的附加指标。这项动物研究的临床意义在于，REG在民用和军用医疗环境中都显示出作为无创、连续和非操作员依赖的CBF AR神经监测仪的潜力。使用REG进行神经监测的人体验证研究目前正在进行中。
Neuromonitoring is performed to prevent further (secondary) brain damage by detecting low brain blood flow following a head injury, stroke or neurosurgery. This comparative neuromonitoring study is part of an ongoing investigation of brain bioimpedance (rheoencephalography-REG) as a measuring modality for use in both civilian and military medical settings, such as patient transport, emergency care and neurosurgery intensive care. In a previous animal study, we validated that REG detects cerebral blood flow autoregulation (CBF AR), the body's physiological mechanism that protects the brain from adverse effects of low brain blood flow (hypoxia/ischemia). In the current descriptive pig study, the primary goal was to compare measurements of CBF AR made with REG to measurements made with other neuromonitoring modalities: laser Doppler flow (LDF); intracranial pressure (ICP); absolute CBF; carotid flow (CF); and systemic arterial pressure (SAP). Challenges administered to anesthetized pigs were severe induced hemorrhage (bleeding) and resuscitation; CO2 inhalation; and positive end expiratory pressure (PEEP). Data were stored on a computer and processed offline. After hemorrhage, the loss of CBF AR was detected by REG, ICP, and CF, all of which passively followed systemic arterial SAP after bleeding. Loss of CBF AR was the earliest indicator of low brain blood flow: loss of CBF AR occurred before a decrease in cardiac output, which is the cardiovascular response to hemorrhage. A secondary goal of this study was to validate the usefulness of new automated data processing software developed to detect the status of CBF AR. Both the new automated software and the traditional (observational) evaluation indicated the status of CBF AR. REG indicates the earliest breakdown of CBF AR; cessation of EEG for 2 seconds and respiration would be used as additional indicators of loss of CBF AR. The clinical significance of this animal study is that REG shows potential for use as a noninvasive, continuous and non-operator dependent neuromonitor of CBF AR in both civilian and military medical settings. Human validation studies of neuromonitoring with REG are currently in progress.