最佳压力反应率指数范围是特定于疾病的:动脉瘤下关节出血和创伤性脑损伤之间的比较
Teodor Svedung Wettervik1, Timothy Howells2, Anders Hånell2
1Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden. teodor.svedung-wettervik@neuro.uu.se.
Journal of clinical monitoring and computing
|May 3, 2024
概括
最佳的大脑压力反应指数 (PRx) 范围在动脉瘤下关节出血 (aSAH) 和创伤性脑损伤 (TBI) 患者之间有所不同. 在aSAH中,极端的PRx值是有害的,而在TBI中,只有升高的PRx是不利的.
科学领域:
- 神经临界护理是指神经临界护理.
- 脑血管生理学 脑血管生理学
- 神经系统监测神经系统监测
背景情况:
- 脑压力自调节受损是急性脑损伤后的一个重要并发症.
- 延迟大脑缺血症在动脉瘤下关节出血 (aSAH) 中比创伤性脑损伤 (TBI) 更为普遍.
- 压力反应率指数 (PRx) 的最佳范围在不同类型的急性脑损伤之间可能有所不同.
研究的目的:
- 调查与aSAH和TBI患者的功能结果相关的最佳PRx范围.
- 为了比较aSAH和TBI队列之间的自我调节障碍.
主要方法:
- 一项观察性研究包括487名aSAH和413名TBI患者.
- 对PRx的良好监测时间 (%GMT) 的百分比是通过定义的间隔计算的.
- 分析了PRx与有利的功能结果相关 (GOS-E 58).
主要成果:
- 在aSAH患者中,在 -1.0至 -0.5和+0.75至+1.0间隔内,PRx的更高%GMT与较差的结局有关.
- 在TBI患者中,只有在+0.75至+1.0间隔内更高的PRx%GMT与不良结果有关.
- 这些发现表明,不同的PRx模式影响了aSAH与TBI的结果.
结论:
- 极端的PRx值 (负值和正值) 在aSAH中是有害的,可能反映血管或肌性过敏反应.
- 在TBI中,只有升高的PRx值表明不良的预后,可能是由于压力被动大脑循环.
- 根据损伤类型定制神经监测和管理策略可能会改善患者的治疗结果.
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