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脑血管反应率 (PRx) 和最佳脑 perfusion 压力在老年人的创伤性脑损伤

Samuel Lenell¹, Teodor Svedung Wettervik², Timothy Howells²

¹Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden. samuel.lenell@neuro.uu.se.

Acta neurochirurgica

|February 2, 2024

概括

老年创伤性脑损伤患者的脑压自调节 (CPA) 更差,脑输液压 (CPPopt) 更高. 与年轻患者不同,老年人没有从保持CPP附近的CPP中获益.

科学领域:

神经科学是一个神经科学.
关键护理医学关键护理医学
老年医学老年医学

背景情况:

通过 PRx 和最佳 CPP (CPPopt) 评估的大脑压力自调节 (CPA) 状态引导的大脑输液压 (CPP) 管理,显示出有希望.
然而,它在老年创伤性脑损伤 (TBI) 患者中的应用和有效性仍未得到充分研究.

研究的目的:

在老年TBI患者中分析PRx和CPPopt的特征.
为了比较这些参数及其对老年人和年轻TBI患者队列的结果的影响.

主要方法:

对129名老年人 (≥65岁) 和342名年轻人 (16-64岁) TBI患者的平均动脉血压 (MAP) 和内压 (ICP) 监测数据的回顾性分析.
计算CPP,PRx,CPPopt和ΔCPPopt (实际CPP和CPPopt之间的差异).
使用后勤回归和热图分析来评估PRx,ΔCPPopt和患者结局之间的关系.

主要成果:

与年轻患者相比,老年患者表现出更高的PRx值,表明CPA更差,CPPopt更高.
虽然高PRx对两组的结果产生了负面影响,但其影响在老年人中不那么明显.
在年轻患者中,有利的结果与CPP相关,接近CPPopt,但在老年人中没有这种关联.

结论:

老年TBI患者表现出明显的CPA动态,其特点是更高的PRx和CPPopt.
保持CPP接近CPPopt的治疗策略可能不会在老年TBI患者中提供与年轻人观察到的相同的生存益处.

关键词:

大脑的自我调节.年长的老人.神经密集型护理监测监测神经密集型护理最佳的大脑 perfusion 压力是最好的.压力反应率指数是压力反应率指数.创伤性脑损伤是一种创伤性脑损伤.

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