Critical Closing Pressure During Intracranial Pressure Plateau Waves
Critical Closing Pressure During Intracranial Pressure Plateau Waves
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DOI：
10.1007/s12028-013-9830-5
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发表时间：
2013-06-01
影响因子：
3.5
通讯作者：
Czosnyka, Marek
中科院分区：
文献类型：
--
作者：
Varsos, Georgios V.;de Riva, Nicolas;Czosnyka, Marek
临界闭合压（CCP）是指动脉血压（ABP）的阈值，低于该阈值，脑血管塌陷并且脑血流停止。理论上，CCP是颅内压（ICP）和动脉壁张力（WT）的总和。本研究的目的是描述ICP自发升高期间CCP和WT的行为（称为平台波），以量化缺血风险。为了计算CCP，我们使用了最近引入的多参数方法（CCPm），该方法基于脑血管阻抗的模。CCP来自脑灌注压、ABP、脑血管阻力和顺应性的经颅多普勒估计值以及心率。动脉WT估计为CCPm-ICP。临床资料包括20例颅脑损伤后38次ICP平台波的ABP、ICP和经颅多普勒血流速度记录，总体上，CCPm从基线ICP的51.89 ± A8.76 mmHg显著增加到平台波顶部的63.31 ± A10.83 mmHg（平均值+/-Δ SD; p < 0.001）。在平台波期间，脑动脉WT显著降低34.3%（p < 0.001），证实其血管舒张起源。CCPm没有表现出非生理性的负值，已经看到与传统的计算方法，因此呈现出一个更合理的估计CCP。上升CCP在高原波增加脑血管塌陷和零流量的可能性时，差异：ABP-CCP（“崩溃的边缘”）成为零或负。
Critical closing pressure (CCP) denotes a threshold of arterial blood pressure (ABP) below which brain vessels collapse and cerebral blood flow ceases. Theoretically, CCP is the sum of intracranial pressure (ICP) and arterial wall tension (WT). The aim of this study is to describe the behavior of CCP and WT during spontaneous increases of ICP, termed plateau waves, in order to quantify ischemic risk.To calculate CCP, we used a recently introduced multi-parameter method (CCPm) which is based on the modulus of cerebrovascular impedance. CCP is derived from cerebral perfusion pressure, ABP, transcranial Doppler estimators of cerebrovascular resistance and compliance, and heart rate. Arterial WT was estimated as CCPm-ICP. The clinical data included recordings of ABP, ICP, and transcranial Doppler-based blood flow velocity from 38 events of ICP plateau waves, recorded in 20 patients after head injury.Overall, CCPm increased significantly from 51.89 +/- A 8.76 mmHg at baseline ICP to 63.31 +/- A 10.83 mmHg at the top of the plateau waves (mean +/- A SD; p < 0.001). Cerebral arterial WT decreased significantly during plateau waves by 34.3 % (p < 0.001), confirming their vasodilatatory origin. CCPm did not exhibit the non-physiologic negative values that have been seen with traditional methods for calculation, therefore rendered a more plausible estimation of CCP.Rising CCP during plateau waves increases the probability of cerebral vascular collapse and zero flow when the difference: ABP-CCP (the "collapsing margin") becomes zero or negative.