FOCAL CEREBRAL ISCHEMIA IN ACUTE BRAIN INJURY

急性脑损伤引起的局灶性脑缺血

• 批准号: 6112627
• 负责人: MICHAEL N DIRINGER
• 金额: $ 12.12万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-06-01 至 2000-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6112627
• 关键词: acute disease /disorder; adult human (21+); bioimaging /biomedical imaging; blood flow measurement; blood volume; brain injury; brain metabolism; cerebral ischemia /hypoxia; clinical research; human subject; pathologic process; positron emission tomography; respiratory oxygenation

Each year approximately 2 million people suffer traumatic brain injuries (TBI) in the U.S. of these about 100,000 die and 90,000 are left with long-term disabilities. Advances in the management of these patients have reduced mortality but done little to ameliorate brain injury. Recent studies in severe TBI patients have suggested that reduced regional cerebral blood flow (rCBF) in the first few hours after injury contributes to secondary brain injury. in order to determine the role of cerebral ischemia in the pathophysiology of TBI, it is important to determine if the reduction in rCBF seen in TBI patients is due to a primary reduction in supply causing ischemia or merely represents a decline in rCBF secondary to reduced metabolic demands of injured brain tissue. Positron emission tomography (PET) is the only technology currently available that can quantify CBF and CMRO2 regionally in humans, and provide indices of the balance between CBF and CMRO2; oxygen extraction fraction OEF, differences in arteriovenous O2 content (A-VDO2), and cerebrovenous oxygen content (CvO2). Barnes-Jewish Hospital at Washington University Medical Center is a Level I trauma center which admits approximately 120 TB1 patients each year. A new Siemens ECAT EXACT HR 47 PET scanner has been installed in the Neurology/Neurosurgery Intensive Care Unit (NNICU) and is currently being used to study TBI patients. The presence of a PET scanner in the NNICU, combined with our extensive experience with the use of PET to detect ischemia, our expertise in the clinical management of TBI patients, and the large available patient patient population gives us a unique opportunity to address these issues. We propose to investigate the prevalence, severity, and duration of cerebral ischemia in severe TBI. Specifically we will measure regional CBF. CMRO2, CvO2, A-VDO2 and OEF using PET in 60 patients with severe head injury (GCS less then or equal to 8) within the first 12 hours after injury and again 24-72 hours latter. These investigations are critical to optimize treatment for these patients. If ischemia is a significant problem in TBI, then management of arterial hypertension and cerebral perfusion pressure will need to modified accordingly. In addition neuroprotective agents currently being studied in ischemic stroke may be useful in TBI as well.

每年约有200万人遭受创伤性脑损伤 (TBI)在美国，大约有10万人死亡，9万人留下 长期残疾。 这些患者的管理进展 降低了死亡率，但对改善脑损伤几乎没有作用。 最近 对严重TBI患者的研究表明， 脑血流量（rCBF）在受伤后的最初几个小时内有助于 继发性脑损伤 为了确定大脑的作用 缺血在TBI的病理生理学中，重要的是确定是否 TBI患者的rCBF降低是由于原发性脑损伤 或仅代表rCBF下降 继发于受损脑组织的代谢需求降低。 正电子 发射断层摄影术（PET）是目前唯一可用的技术， 可以量化CBF和CMRO 2在人类区域，并提供指标， CBF和CMRO 2之间的平衡;氧提取分数OEF， 动静脉氧含量（A-VDO 2）和动静脉氧含量差异 含量（CvO 2）。 华盛顿大学医学院巴恩斯犹太医院 中心是一级创伤中心，可容纳约120 TB 1 患者每年 一款新的Siemens ECAT EXACT HR 47 PET扫描仪已经在 安装在神经科/神经外科重症监护室（NNICU）， 目前用于研究TBI患者。 PET扫描仪的存在 在NNICU中，结合我们在PET使用方面的丰富经验， 为了检测缺血，我们在TBI临床管理方面的专业知识 患者，以及大量可用的患者人群为我们提供了一个 解决这些问题的独特机会。 我们建议调查 严重TBI患者脑缺血的患病率、严重程度和持续时间。 具体来说，我们将测量区域CBF。 CMRO 2、CvO 2、A-VDO 2和OEF 对60例重型颅脑损伤（GCS ≤）患者进行PET检查， 至8）在损伤后的前12小时内，以及在损伤后24-72小时内。 这些研究对于优化这些疾病的治疗至关重要。 患者 如果缺血是TBI中的一个重要问题，那么 动脉高血压和脑灌注压将需要 相应修改。此外，目前正在使用的神经保护剂 在缺血性中风中研究的可能在TBI中也有用。