在选择性神经外科手术中,大脑自调节衍生出血压目标
Erta Beqiri1, Marta García-Orellana2,3, Anna Politi4
1Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. vb391@cam.ac.uk.
Journal of clinical monitoring and computing
|January 18, 2024
概括
使用COx监测大脑自身调节 (CA),可以实现个性化的血压管理. 这项研究表明,对神经外科病人的最佳血压 (ABP_OPT) 和自调的下限 (LLA) 的自动评估是可行的.
科学领域:
- 神经外科 神经外科
- 密集护理医学 密集护理医学
- 生理学 生理学 生理学
背景情况:
- 术后的不良结果与大脑自身调节 (CA) 范围之外的动脉血压 (ABP) 有关,导致缺血或高血压.
- 使用COx (ABP与大脑氧化之间的相关性) 进行大脑自调节 (CA) 监测可以个性化ABP管理.
- 个性化ABP目标可以保护CA并改善患者的治疗结果.
研究的目的:
- 探索ABP_OPT (最佳CA的动脉血压) 和LLA (自我调节的下限) 的持续自动评估.
- 在接受选择性神经外科手术的患者中评估这些评估的可行性.
- 确定可用性和时间来实现第一个ABP_OPT和LLA值.
主要方法:
- 对85名选择性神经外科患者的前性收集数据的回顾性分析.
- 持续监测ABP和区域大脑氧和 (rSO2) 波形.
- 为ABP_OPT和LLA计算的COx衍生趋势线;与基线ABP进行比较.
主要成果:
- ABP_OPT和LLA分别在86%和89%的患者中可用.
- 达到第一个ABP_OPT和LLA值的中位时间约为95分钟.
- 中位数ABP_OPT明显低于基线ABP;患者在ABP_OPT±5mmHg范围之外的ABP上花了相当长的时间.
- 37.6%的患者至少经历过一次低血压损伤 (ABP < LLA).
结论:
- 在选择性神经外科手术中,对ABP_OPT和LLA的持续自动评估是可行的.
- 可以建立基于CA监控的个性化ABP目标.
- 这种方法可以帮助预防低血压的攻击,并优化外科手术期间的血压管理.
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