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Teodor Svedung Wettervik^1,2, Erta Beqiri³, Anders Hånell⁴

¹Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden. teodor.svedung-wettervik@neuro.uu.se.

Acta neurochirurgica

|February 27, 2025

概括

高压反应指数 (PRx) 的老年创伤性脑损伤 (TBI) 患者的结果更差. 自主调节引导的管理可能有利于60岁以上的TBI患者,因为PRx可以独立预测所有年龄组的结果.

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
神经外科手术神经外科手术

背景情况:

创伤性脑损伤 (TBI) 是导致死亡和残疾的重要原因.
通过压力反应指数 (PRx) 评估的大脑自身调节,通常在老年TBI患者中受损.
在老年TBI患者中,PRx和最佳脑 perfusion 压力 (CPPopt) 的预后值仍然不清楚.

研究的目的:

调查年龄对TBI患者中PRx和CPPopt预后意义的影响.
为了确定自调节变量是否在TBI中具有跨年龄组的差异性预后值.
评估老年TBI患者自调导治疗的潜在益处.

主要方法:

一项观察性研究包括550名TBI患者,具有有关年龄,内压力监测和格拉斯哥结局量表 (GOS) 的可用数据.
患者分为三个年龄组:16-39岁,40-59岁和60岁以上.
多变量逻辑回归分析了PRx和CPPopt (ΔCPPopt) 与死亡率和有利结果 (GOS 4-5) 的关联.

主要成果:

高龄的TBI患者 (60岁以上) 与年轻人群相比,表现出更高的PRx和更低的内压力 (ICP).
在所有年龄组中,更高的PRx始终与更差的结果有关.
高PRx结合低脑输液压 (CPP) 或负 ΔCPPopt 与较低的 GOS 分数相关. 较高的PRx独立预测死亡率和不良结果在老年人群.

结论:

PRx是所有年龄段的TBI患者的独立预测结果.
PRx影响安全和危险的CPP和DCPPopt间隔,指导管理决策.
60岁以上的TBI患者可能受益于自我调节引导的管理,并应考虑相关的临床试验.

关键词:

年龄年龄年龄年龄年龄年龄神经临界护理是指神经临界护理.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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